Are you a new patient?
Print, Email or Fax the forms below to expedite your check-in process.
* To email the forms you must fill out and save it to your computer then email it to us as an attachment.
|Advance Beneficiary Notice (ABN)||English||Chinese||Spanish|
|Patient Consent Form (HIPAA)||English||Chinese||Spanish|
|HIV Consent Form||English||Chinese||Spanish|
|Medical Release Form||English||Chinese||Spanish|
Are you a returning patient?
Has your information changed? Address, insurance, employment, etc…?
Paying by Credit Card?
Please fill out this form, bring it with you, email or fax it to us.
|Credit Card Authorization Form||English||Chinese||Spanish|
What you’ll need on your visit:
- All current insurance cards
- One (1) Official picture ID (Driver’s license, passport…)
- Co-pay is expected prior to being seen, no personal checks acceptable.
- Please arrive on-time