Request an appointment

Welcome to Vita Health!

To get started, please book a free call below. We'll walk you through how Vita Health works and get you scheduled with a clinician as soon as possible.
Vita email
example@example.com
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Select a time to talk to a Vita Health care coordinator*
Contact information

Please enter the information of the person seeking care.
Legal name*

First NameLast Name
Preferred name
Pronouns

She/her/hersHe/him/hisThey/them/theirsOther
Phone number*
Email*
We'll send paperwork to this email
State*
Postal / zip code*
Insurance provider*
Please enter the name of your insurance provider, e.g. "Aetna", "Blue Cross Blue Shield", etc.If you don't know, please enter "I don't know"
Preferred language*

EnglishEspañol (Spanish)
Date of birth*

MonthDayYear
Is the person seeking care under 18 years of age?*

YesNo
Parent / legal guardian name*

First NameLast Name
Parent / legal guardian phone number*
Parent / legal guardian email*
How did you hear about Vita Health?*

DoctorEmployerFacebookFriend or familyGoogleInsuranceSchoolOther
Doctor's name
Practice name
Practice location
School name
Employer name
Should be Empty: