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*
Please verify that you are human*
By providing your details and clicking "Submit" you agree to:
- Receive communications from Adventist Health through email, SMS, text, or calls by an automated telephone dialing system for the purpose of Adventist Health maintaining its relationship with you and providing you information related to services you may be interested in.
- Adventist Health collecting and disclosing to third parties personal information and communications for the purpose of fulfilling your inquiries or requests for services or information.
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