Appointments: (805) 383-0647

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Appointments: (805) 383-0647

  • Home
  • About
  • Contact
  • Patient Portal
  • FORMS

Downloads

Starting January 2019, ALL patients are required to fill out the top 3 forms (Notice of Privacy, Financial Policy & Authorization Form). These forms only have to be filled out ONCE unless any changes to be reported. Please print, sign, and bring to your appointment to minimize any delays. Your cooperation is greatly appreciated. 

Notice of Privacy Practice (pdf)Download
Financial Policy (pdf)Download
Authorization Form-HIPAA (pdf)Download

Downloads

Medical Records Release form (pdf)Download
Grievance-appeal form (pdf)Download

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