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Family Medicine at Lakeshore Appointment Request

To request an appointment with a pediatric primary care doctor, please complete the form below and click on "Submit." A representative will contact you within one business day to schedule an appointment.

Please note that currently we are not accepting online appointment requests for new patients at the Lakeshore Family Medicine Center.

If you have any questions, comments or complaints about your appointment request, please use our Contact Us form.

This service is for non-urgent appointments only. If you have a medical emergency, please call 911.

* Required

Patient Information

New patient?

Yes No

Last Name*

First Name*

Middle Name

Date of Birth*

Contact Information

Are you the patient?

Yes No

Preferred Contact Method

Daytime phone*

Alternate phone

Best Time to Call Between 8 a.m. and 5 p.m., Monday - Friday

Medical Information

Medical Plan

Medical Group Number/Subscriber Number

Preferred health professional

First available doctor

Nurse practitioner

Time

Preferred Appointment Time

	M	Tu	W	Th	F
AM
PM

Select All Times
Clear All Times

Reason For Your Visit

Briefly describe the reason for your visit

Other comments

To speak to a representative about making an appointment, please call the following numbers from 8 a.m. to 5 p.m., Monday to Friday:

Family Medicine at Lakeshore (415) 353-9339

For help selecting a doctor, please visit our online Physician Referral Directory. You can also reach our Referral Center at (888) 689-UCSF from 8 a.m. to 5 p.m. (PST) Monday to Friday, or by email at [email protected].

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