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Upstate University Hospital
Request an Appointment/Referral

Thank you for considering Upstate for your care. We are here to care for you at any age and in any condition to improve your health. Please complete this form, and we will send you information about our health care providers that best match your needs. If an Upstate provider does not meet your needs, we will refer other providers in the community to you. Providers do not pay us for a referral or pay to participate in our referral service.

For more information about specific health care providers, conditions or treatment options, visit https://www.upstate.edu/healthcare/providers/

(Please do not use this form to send Consult Requests or personal emails to physicians.)

Fields with * are Required

Patient Information

The person who will be seeing the physician.

    
Contact Person

The person completing this form.

Doctor/Area of Interest
Brian Harley, MD, FRCSC, Orthopedic Surgery
Additional Information

If this is a true medical emergency, do not wait for a response, call 911. Please allow 72 hours for a response to this form

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