Book an Appointment

This online form is for New Patients Only
Established patients must call (818) 842-1410 to request appointments.

Please be advised that Dr. Thaik’s schedule is booked months in advance with established patients. In an effort to minimize wait times and ensure timely access to care, we have implemented a system of double-booking one new patient into each hour. Please anticipate a potential wait and expect the appointment to commence sometime within the scheduled hour. We appreciate your understanding and patience as we strive to accommodate your needs and minimize prolonged waiting periods.

Please complete fillable intake form and email back to staff@drcynthia.com prior to visit.

This online form is for New Patients Only
Established patients must call (818) 842-1410 to request appointments. Any new patient can also call for appointment requests.

"*" indicates required fields

Name*

Date of Birth*

Pronoun*

Address*

Email*

Phone*

Name of Insurance*

Type of Insurance*

Other Insurance

Member ID Number*

Insurance Phone Number

Secondary Insurance Information

Secondary ID Number

Reason for Consultation*

Preferred Location*

Office

Telemedicine

Only one telemedicine appointment slot available each day in late afternoon.

Preferred day of the week

Mon

Tue

Wed

Thu

Preferred time of the day

Morning

Afternoon

Referring MD (If applicable)

Comments

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Book an Appointment

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