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Appointment Request

You can schedule an appointment at HCI Medical Group by calling (626)792-4185 (option 3 in the voice menu) or by completing the form below.

If you complete the form below, please use a telephone number where you can easily be reached as our receptionist will need to speak to you in person to confirm your appointment.

First Name
Last Name
Email Address	(example: john@yahoo.com)
Telephone Number	(please use the format 555-555-1212)
New or Existing Patient?
Preferred Doctor
Appointment Time
Appointment Date	(click the button to the left to open a calendar)