Patient Forms
The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.
Please printout and complete the appropriate forms:
New Patient Packet – English (PDF)
New Patient Packet – Spanish (PDF)
Authorization for Use or Disclosure of Health Information
Note: The above documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.
Some of the Insurances We Accept:
- Aetna
- Affiliated Health Funds
- Beech Street
- Blue Cross
- Blue Shield
- Coventry/First Health Network
- Choice Care/Humana
- Cigna/Great-West Healthcare
- Health Net
- Interplan
- Medicare
- Multiplan/PHCS
- Riverside County Foundation
- Tri-West Healthcare (Tricare)
Regional Medical Group Provider
We are an exclusive provider for HMO patients with Regal Medical Group.
Learn more about how Regal Medical works for you by watching a quick video: