Medical Forms
Print and fill out these medical forms and bring them with you to expedite your check-in process.
| Form | English | Spanish | Chinese |
|---|---|---|---|
| Patient Registration | Download Patient Registration | Descargar | 下載 |
| Advance Beneficiary Notice (ABN) | Download Advance Beneficiary Notice | Descargar | N/A |
| Patient Consent Form (HIPAA) | Download Patient Consent Form | Descargar | 下載 |
| HIV Consent Form | Download HIV Consent Form | N/A | N/A |
| Medical Release Form | Download Medical Release Form | N/A | N/A |
| Medical History | Download Medical History | N/A | N/A |
Paying by Credit Card?
Please fill out this form, bring it with you, email or fax it to us.
| Credit Card Authorization Form | English | N/A | N/A |
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 |
