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New Patient Online Form

We are primarily a Walk-In Clinic.  If you are New we only ask that you arrive no later than one hour before closing so that you can fill out the New Patient paperwork and have time to spend with our Provider who will select an individual weight loss plan to help you reach your goals. If you are a New Patient and prefer to make an appointment, feel free to call any one of our three offices and we will be happy to set up an appointment for your first visit.

Birthday
Month
Day
Year
Preferred Location
Do You Smoke?
Family or Personal History of:
How did you hear of us?

8977 Foothill Blvd Ste G. Rancho Cucamonga CA. 91730

2598 S. Archibald Ave Ste I.  Ontario CA 91761 

1014 W. West Covina Parkway  W. Covina CA 91790

909-466-3737 Rancho

909-923-2670 Ontario
626-337-3770 W Covina

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