Advanced Heart Failure Evaluation and Therapies Program
Appointment Request

To request an appointment with a heart failure doctor in cardiology, please complete the form below and click on "Submit." A representative will call you within five business days to schedule an appointment. If you are a new patient, please refer to the Referral Information section below and ask your local cardiologist or primary care physician to complete the applicable referral form.

This service is for non-urgent appointments only. If you have a more urgent need, please call our office directly at (415) 353-4145. If you have a medical emergency, please call 911.

If you have any questions, comments or complaints about your appointment request, please use our Contact Us form.

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Patient Information

Contact Information

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Medical Information

First available doctor

Referral Information

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We will contact your insurance company to validate membership and to obtain any required authorization, prior to your visit date.

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If you are a physician, please review and complete the information outlined on the referral form below. All patients require initial review of records by our medical director prior to scheduling the first appointment.

Referral Form for Parnassus Clinic
Referral Form for Fremont Specialty Care Clinic

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Location and Time

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Reason For Your Visit


To speak to a representative about making an appointment, please call the following number from 8 a.m. to 5 p.m., Monday to Friday:

Advanced Heart Failure Evaluation and Therapies Program Administrative Office
500 Parnassus Ave., Fourth Floor, Milberry Union West W420
San Francisco, CA 94143-0115
Phone: (415) 353-4145 (option 1)

For help selecting a doctor, please visit our online Physician Referral Directory. You can also reach our Referral Center at (888) 689-UCSF from 8 a.m. to 5 p.m. (PST) Monday to Friday, or by email at

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