If you are experiencing a medical emergency, please call 911 and do NOT use this online form.

Thank you for choosing Cooper and our online appointment request feature.

You will be contacted by a Patient Access Navigator within two (2) business days of submitting this form to schedule your appointment.

If you need an appointment sooner, or the medical specialty is not listed, please contact us at 1.800.8.COOPER (1.800.826.6737) to speak with a Patient Access Specialist who will be happy to assist you.