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Enter Patient Information
First Name
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Last Name
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Date of Birth
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Please select the reason for visit:
* Telemed
Annual exam or pap smear (appointment)
chest x-ray rule-out TB
Consult
COVID testing City of LN
DHHS Sports
DHHS Sports - Fball
DMV/DOT Physical
Drug Screen
Immigration Physical
Lab work only (visit already completed)
Lung function test/PFT
Medication refill
Pre-employment physical
Pre-op physical
Sick
Sports physical
TB read
TB test
Vaccination
Workers Comp
Are you aware that you are utilizing our on-line check-in for the date of service for TODAY (and not a future date)?
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Is this your first visit to South Coast Family Medical Center?
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Please make sure your phone number is ACCURATE and a CELL phone (not a land line) otherwise you will not receive our texts.
Email Address
Cell Phone Number
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Text message confirmation will be sent.
Contact Name (if different from patient)
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