Welcome to our on-line front desk
Here, you can take advantage of the Internet and receive our services from our office without leaving your computer. We are pleased to offer you the opportunity to print out the following forms.
In order to provide you with the best possible care, we need the most up-to-date information about you. For your convenience, we have provided our office forms here for you to print, complete, and bring or fax to the office (FAX 707-545-8817) prior to your next scheduled visit.
Please print all the forms
Patient Registration Form and Health History Form
We request this form be updated at each visit if any changes in your demographics have occurred. (any changes in name, address, telephone numbers, employment, and/or insurance carriers)
We ask you to complete this once; however if any new medical conditions have arisen, then please notify the staff or your doctor at your following visit to update your medical chart.
1. Welcome letter [download file]
2. Patient Registration Form - Health History Form [download file]
HIPPA Form (Health Insurance Portability and Accountability Act)
Please sign this form once a year. This form reminds everyone the importance of confidentiality of your medical information.
3. HIPPA Form, 3 pages [download file]
Patient Release of Records Request Form
If you have records that need to be transferred from another location or need your current records to be sent to another doctor or facility, please fill out the form and return to or fax to the office. (FAX 707-545-8817)
4. Patient Release of Records Form [download file]
To print the forms above, you must have the Adobe Acrobat Reader on your computer. Download this free program by clicking the “Get Acrobat Reader” button . Follow the instructions, and the download will just take just a few minutes. Then you will be able to print out the forms above.