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Appointment Request Form

As an alternative to phoning our offices for medical appointments, South Bay Family Medical Group has established this portion of our Web site to allow you to request an appointment online. It is not for emergency situations. In the case of an emergency, call 911 or go to the nearest hospital emergency room.

If you have an urgent medical problem, please call our office:

Torrance Office: (310) 378-2234
Manhattan Beach Office: (310) 939-7858

We will respond to your online appointment request within 48 hours Monday - Friday during normal business hours. This service is for the patient who wants to make an appointment for the upcoming week or month - it is NOT for same day or next day appointments. If you require an appointment sooner than two business working days, please call our office.

To make an appointment, please complete this form online and click the "Send Request" button at the bottom of this page. *Required field.

Name of Patient:
Patient's birthdate:
Name of person making the appointment (if not the patient):
Relationship to patient:
Are you a first-time patient?		Yes No

I would like to make a non-urgent appointment with:		Tanya Arvan, M.D. Beth A. Dorn, M.D. Nancy Griffith, M.D. George Joseph, M.D. William Kim, M.D. Lee Kissel, M.D. Maria Lui, M.D. Anna Basile Mellor, M.D. Eric Michael Munro, M.D., M.P.H. F. Lee Reitler, M.D. Danette Taylor, M.D. Scott Tong, M.D. David H. Wallis, M.D.

I need to see the doctor for:		Annual comprehensive physicial Annual pap smear/well woman exam Medication follow-up New medical problem Re-check on medical condition School physical Several medical problems Well baby check

I don't need to see the doctor. I need to have blood drawn for:

I prefer the following day of the week:		Monday Tuesday Wednesday Thursday Friday Saturday

I prefer an appointment at the following hour:		AM PM

If we have questions or there is a scheduling conflict please supply the following information:

Home Telephone Number: *
Work Telephone Number:
Your E-mail Address: *

Manhattan Beach Office
(310) 939-7858

Torrance Office
(310) 378-2234

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Appointment Request Form