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Get instant 24/7 access to your health information with myUCLAhealth

This practice is proud to offer myUCLAhealth

Whether you're at work, on the road or at home, you can now actively manage your appointments, communicate securely with your care team, view lab results, and much more. Ask about registration for myUCLAhealth during your office visit today. 
Current Patients: Visit myUCLAhealth to learn more » 
New Patients: Request an appointment »

Patients can download/print the following forms to complete and bring to their appointment. (You will need adobe reader to download PDF forms below. )

UCLA Health Santa Monica Pediatrics Office.

Patient Forms


Your Feedback Matters To Us 

We're calling...

UCLA Health seeks to provide the best possible care and service to all patients. We want to know how we're doing, and our representative from a company called Quality Data Management (QDM) may be calling you to perform a patient survey by telephone.

  • You may be selected randomly to be interviewed over the phone within a few weeks of your visit.
  • QDM will ask you about your experience with your doctor and this practice.
  • Your responses are confidential and you will not be identified.
  • Participation in the survey will not affect your health care or your benefits.
  • We encourage you to take the survey, but the choice is up to you. We value your input because it helps us improve the quality of care we provide.

...to hear your opinion

Thank you,
UCLA Health