MedicsPremier - Patient Portal

New Patient

27410 Los Altos
Suite 180
Mission Viejo, CA 92691

Appointment Selection

Please note that your booking request is preliminary and is subject to office approval. Once your appointment has been approved you'll receive a confirmation e-mail. You may book up to 60 days in advance.

Provider/Doctor: *

Appointment Type: *

Authorization/Certification Number:

Availability for 01/26/2023

Open appointment times within 4 hours of the current time are not shown. Please call the office if you require immediate availability.

Please make a selection above.

Fields marked with a (*) are required.

Patient Profile

Please type in your information below.

First Name: *

Middle Name:

Last Name: *

Date of Birth: *

Sex: *

Home Phone Number: *

Mobile Phone Number:

Street Address: *

Apt/Suite/Other:

City: *

State: *

Zip Code: *

Fields marked with a (*) are required.

Online Account

Please select a username for your online patient portal account below.

Username: *

E-Mail: *

Password: *

Confirm Password: *

Passwords should be a minimum of eight (8) characters.

Fields marked with a (*) are required.