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.

• Patient Registration – English | Chinese | Spanish
• Advance Beneficiary Notice (ABN) – English | Chinese | Spanish
• Patient Consent Form (HIPAA) – English | Chinese | Spanish
• HIV Consent Form – English | Chinese | Spanish
• Medical Release Form – English | Spanish
• Medical History – English

Are you a returning patient?

Did any of your information change? Address, insurance, employment, etc…?

Print, Email or Fax the forms below to expedite your check-in process.

• Patient Registration – English | Chinese | Spanish
• Advance Beneficiary Notice (ABN) – English | Chinese | Spanish
• Patient Consent Form (HIPAA) – English | Chinese | Spanish
• HIV Consent Form – English | Chinese | Spanish
• Medical Release Form – English | Spanish
• Medical History – English

Has your information changed?

• Information Change – 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