Waitlist

Join the PJM Clinic Patient Waitlist

PJM Clinic is opening soon in Glendale. Joining the waiting list does not book an appointment. We’ll reach out when we open. For emergencies, call 911.

First and last name *

Phone *

Email (optional)

Preferred contact method *

Phone call Text Email

Insurance *

Plan or carrier name (optional)

Are you: *

New patient Existing PJM patient

What type of visit?

Best time to reach you

This form is for scheduling only. It is not for emergencies or medical questions. If you have a medical emergency, call 911. Please do not include symptoms, diagnoses or other medical details. By submitting, you agree that PJM Clinic may contact you by your chosen method about scheduling and clinic availability. Message and data rates may apply. Joining the waitlist does not create a patient-provider relationship or guarantee an appointment or insurance coverage. Self-pay patients may request a Good Faith Estimate. Consent to calls or texts is not a condition of receiving care. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. See our Privacy Policy.

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