• Make a doctor's appointment
• Prepare for your doctor's visit

Request for General Information

This form is unsecured, and is for general information requests only. Please do not use this form for questions or comments regarding personal health information, or for time-sensitive matters. Instead, please contact your provider, 1-888-4PACMED (1-888-472-2633) or one of our pharmacies by telephone or in person in order to protect the confidentiality of your personal information.

We cannot provide medical advice by e-mail. If you are a PacMed patient, ask your doctor about a MyChart account. MyChart lets you message your provider securely, as well as view your health record, request appointments, request prescription renewals and view and print your test results. In the case of a medical emergency, please call 911.

Please read the following and check the box below if you would like to communicate electronically with us regarding general matters:

Electronic communication with Pacific Medical Centers ("PacMed"), whether by e-mail or through this website, is an unsecured means of communication. PacMed cannot guarantee the confidentiality or privacy of information communicated electronically. Such information may be read by people other than myself or my health care provider (such as my employer if I use my work e-mail or computer; my internet service provider; or a PacMed administrative employee). In addition, electronic communication is not a reliable means of communication regarding time-sensitive matters.

Questions or comments regarding personal health information or time-sensitive matters must be communicated in person or by telephone.

1. 
     By checking this box, I understand and agree to the above, and I authorize Pacific Medical Centers (PacMed) to send electronic mail to me at any address I use to send messages to them.*
   
   
2. Are you a current patient? *
   Yes   No
3. Name *
   
4. Email *
   
5. Confirm email *
   
6. Message *