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Santa Monica Parkside - Appointment Request

New patients, or current patients who do not have a myUCLAhealth account, can use this form to request an appointment. Current patients with a myUCLAhealth account, please sign in to my.uclahealth.org to request an appointment.

Thank you for your interest in making an appointment with one of our Santa Monica Parkside office physicians. Please provide the requested information below and we will respond to your request as soon as possible. If you need to speak with someone immediately, or if you prefer to discuss the reason for your appointment over the telephone, please call us during regular business hours at (310) 998-5868.

Please note that special charges related to your care may apply. Some examples of these special charges for your continued care include, but are not limited to, Missed Appointments, Completion of Forms, and Telephone/Email Consultations. Should you have any questions about these charges, please feel free to contact our clinic directly.
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