Request an Appointment

Request an Appointment

First Name (required): Last Name (required):
Date of Birth (required):  

Current or New Patient? (Required):
New Patient Current Patient

Contact Information:
First Name (required) Last Name (required)
Preferred Contact Email or Phone (required):
Preferred Language (required):

Additional Comments (Optional):

Please verify the box below

Once your online appointment request is received you will be contacted by a Scheduling Representative within 24-48 hours to confirm your appointment. If you are having trouble requesting your appointment online or would like to make your appointment over the phone, please call 909.469.9395 to speak to a Scheduling Representative (Monday-Friday, 8:00am - 4:30pm).
Pomona Valley Hospital Medical Center - 1798 N. Garey Avenue - Pomona, CA 91767 - (909) 865-9500 - Contact Us