Request an Appointment | Coastal Dermatology

Fill out the form below, book online in Santa Maria (opens online scheduler), or give us a call. Cosmetic and aesthetic appointments need no referral. For medical dermatology in San Luis Obispo, we are accepting new patients by referral from your primary care physician; send the referral across and then use the same form. In Santa Maria, medical appointments are available without a referral for PPO patients, and for HMO patients we are in-network with Santa Maria Physician's Choice.

Name

Phone Number

Preferred office

Preferred time

Preferred day

Treatment (optional)

I understand this form is not secure for medical information. I will not share health history, diagnoses, or sensitive details here. The practice is not responsible for any protected health information I include.

A consultation fee of $125 is due at the time of booking.

Request Appointment

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