City Line Family Medicine

301 City Avenue ■ Suite 100 ■ Bala Cynwyd, PA 19004
Phone 610-617-1300 ■ Fax 610-617-0199 ■ Text/Voicemail* 484-429-9141

Non Urgent Message

  • Web service indicates the user's agreement to be bound by the terms of use and knowledge of disclaimers listed.
  • Please allow two business days for a response to your request.  If a response is needed sooner please call 610-617-1300 or text 484-429-9141.
  • Providing incorrect information will delay the processing of your request.  Therefore review your information prior to submitting.
  • This service is only available to current, already established, patients of City Line Family Medicine as defined in the "Terms of Use" page.


 

Patient's Full Name: 
Patient's Date of Birth: - mm/dd/yy
Caller's Full Name if different from patient: 
Home Phone # with Area Code:
Cell Phone # with Area Code:
Select your Primary Care Physician:
   
Please call me regarding my:   
Medication Visit with a Specialist
Forms/Paperwork Non Urgent Medical Problem
Other  
 

In 50 characters or less provide a description of your non urgent issue.

 

 
I understand that a response to this message may take up to 2 business days:   
   

Please press the submit button only once. It may take a few moments for submission. 

*depending upon your calling/texting plan, additional charges may apply.