In order to help us provide you with the best possible treatment and make your appointment with us more convenient, please complete the necessary forms prior to your visit.

  • If you are a new patient please complete the New Patient Information Form as well as the Patient Release Form.
  • If you are a prior patient, and have not be seen for more than three years: Please complete the New Patient Information Form and the Patient Release Form.

Please note that the forms may be completed online. The forms should then be printed at home and brought with you to your appointment. Patient privacy issues (HIPAA) do not allow the forms to be submitted via email.

New Patient Information Form

New Patient Packet (Cosmetic Patients)

New Patient Information Form (Spanish – Español)

Medical Records Release

Notice of Privacy

Parent Guardian Permission to Treat Minor

Insurance Plans Accepted

We are happy to file your insurance claim to these participating companies. This is not an all inclusive list, if you do not see your insurance company listed, please contact our office or your insurance company to verify our participation.

Please always check with your insurance company to confirm that we are in-network participating providers on your health insurance plan to verify your benefits and minimize any out of pocket costs. If we are not in-network on your plan, you will be expected to pay your out-of-network costs for services provided at the time they are rendered.

  • Aetna Gated / Non-Gated
  • Aetna Medicare PPO/HMO/Aexcel
  • BeechStreet PPO
  • BCBS ANTHEM (California)

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