Health Center

Health Center Appointment Request

To request an appointment, please complete the form below and click on "Submit". A representative will call you as soon as possible to schedule an appointment.

If you have any questions, comments or complaints about your appointment request, please contact us at 925.424.1830.

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

Patient Information

* Required Fields

New Patient
Returning Patient
* Last Name:
* First Name:
* Date of Birth / /
(month/day/year - ex: 03/21/1975)
* "W" Number

Contact Information

* Daytime Phone:
Alternate Phone:
* Best time to call you back
(Between 9:30 am and 6:45 pm, Monday to Thursday)
* Email:

Preferred Contact Method:

Appointment Request Information

Preferred day or days for your appointment:
Preferred appointment time:
No Preference

Briefly describe the reason for your visit:

Other Comments:

Enter the code shown in the image:

Health & Wellness Center

Building 1700

Office Hours

Monday, Tuesday, Thursday
9 am - 5 pm

10 am - 6 pm

Friday - Closed

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Page last modified: May 10, 2013