Related Information: VITA: Restoring Life After Cancer What is VITA? Is VITA right for me? Make an Appointment Meet the Team Research Contact Us

To initiate the appointment process, please download and complete the following forms:

• UCLA Medical Records Release Form
  
• VITA Patient Intake Form

Please note that to schedule an appointment, a patient must be able provide access to the medical records from his or her cancer treatments. These records are a vital part of the survivorship consultation visit, and help to ensure that the VITA program can provide the best evaluation and recommendations for follow-up care.

After you have completed both forms, please contact Erin Hahn, M.P.H., at (310) 825-9781 or by e-mail to make an appointment.