Upstate University Hospital
Request an Appointment/Referral

For more information about a department or a physician, please fill out the form below, or call 315 464-8668 or 800 464-8668 (within NYS only) to speak with an Upstate Connect nurse. Unfortunately we can't make appointments on-line through this website, but we will gladly assist in directing you to the proper phone number. Thank you.

Please do not use this form to send Consult Requests or personal emails to physicians. Consult Requests and personal emails will not be forwarded to physicians.

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Patient Information

The person who will be seeing the physician.

    

Requester Information

The person completing this form.

Doctor Information

David W Wormuth, MD, MPH, Surgery - Community Campus


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