Riverside Primary Care Adult & Geriatric Medicine

If you are a returning patient and have access to your Patient Portal, click here to schedule an appointment, or send a message through this form and a provider will be in contact with you shortly.

First Name:

Last Name:

Preferred Name:

Gender:

Date of Birth:

Street Address:

City:

State/Province:

Postal Code:

Country:

Email:

Phone:

Insurance:

** Please note that before we can schedule your appointment, we require your insurance number and group number. This information is necessary for us to run eligibility checks and ensure that we can provide the services you need. Once you select your insurance, we will contact you to collect these details. Thank you for your understanding. **

Insurance ID:

Insurance Group Number:

Preferred Provider:

How did you hear about us?

Message: