Request an Appointment

Request an Appointment
This request is not for same day or urgent issues. If you believe you are having a medical emergency, please call 911 or go to the nearest emergency room immediately.

This is a secure form, and the information you provide will enable us to assist you as efficiently as possible. A representative from Adventist Health Physicians Network will contact you within one business day to finalize your appointment.

For faster assistance, please call (661) 241-6700 (24 hrs/day).
Are you a new or existing patient?*

NewExisting
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

MaleFemale
Phone Number*

Area CodePhone Number
E-mail*
Insurance Provider*
Preferred Physician/Provider (Optional)
Preferred Appointment Date & Time*

MonthDayYear
DateHourMinutesAM/PM Option
Reason for Appointment*
Should be Empty: