SDRC Appointment Request Form

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Please provide Information needed to schedule your appointment:

Please note that PRE-ONLINE REGISTRATION must be completed prior to requesting an appointment!

Log into the student portal via https://rability.ucr.edu/clockwork/custom/misc/index to complete the pre-online registration if you haven't done so already.

Email *

Record my email address with my response

Your Name (First Name and Last Name) *

UCR SID#, if available (enter digits only, e.g. 860000000) *

Email *

Tel/Mobile # (enter digits only) *

What’s your availability for next two weeks? Monday to Friday, 9am-4pm. Appointments last about 45 min. *

Specify which days of the week and which times of the day you are available for the appointment between 9am and 4pm:

What is your student status? *

Current UCR Student: Undergraduate

Current UCR Student: Graduate

Current UCR Student: SOM

Incoming UCR Student: Freshman or Transfer

Incoming Graduate or Medical School Student

Are you a VISITING student from another university

If you are new to SDRC, have you completed the pre-registration in R'Ability https://rability.ucr.edu? If you do not complete the online pre-registration, any scheduled appointment with SDRC may be cancelled. Please complete the pre-registration ASAP.
*

Yes

No: please complete the pre-registration before your appointment, or your appointment may be delayed

N/A: I'm all ready registered with SDRC

Appointment Purpose:

Intake Appointment (initial appointment to register with SDRC)

Informational Appointment (to ask questions, explore options, before being registered with SDRC)- Pre-registration required

Documentation Related

Check-In/Follow-up

Accessible Technology

Other:

What type of disability are you seeking accommodations for? *

Physical disability (e.g. difficulty walking, writing, prolonged sitting/standing, hearing, vision)

Chronic Health condition (e.g., gastro-intestinal issues, chronic fatigue, cancer, diabetes)

Learning Disability (e.g., reading, speech disorder)

Neurodevelopmental/cognitive disability condition (e.g. autism, attention-deficit/hyperactivity disorder, brain injury)

Emotional or mental health concern or condition (e.g., depression, anxiety, post-traumatic stress disorder)

Other disability/condition

Not sure

What type of accommodation(s) are you seeking? *

What type of appointment are you seeking? *

Zoom

In-Person

No Preference

Comments/Notes:

Thank you for contacting us. Based on information provided you will receive an email with your appointment invitation to a Zoom Session. Check your UCR email inbox. Please feel free to call us at 951-827-3861 or email us at SDRC@ucr.edu

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