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Forms & Policies

If this is your first appointment with our practice, please complete the New Patient Information form listed below and bring it with you to your appointment. When you click on the form it will appear on your screen; you can then click on each line of the form and type the requested information. When finished you can print the form from your computer.(Viewing and filling out this form on your computer requires Adobe Reader®. If you don’t have this program, please click below to download for free).

New Patient Information
Información Para Pacientes Nuevos
Medication List
Medical Records Release
Divulgación de Registros Médicos
Patient Consent
Formulario de Consentimiento
Disclosure of Medical Records Consent
La Divulgación de Registros Médicos
No Show and Copay
Si No Se Presenta y Copago
Patient Database
Access to Medical Records
Accounting of Usage of Medical Records
Medical Record Amendment Request
Restriction of Use/Disclosure of Protected Health Information (PHI)
Privacy Complaint
Glucose Log
Prescription Refill Policy
HIPAA Manual
Abnormal Blood Pressure
Calcium Disorder
Cuestionario de Calcio
Diabetes
Cuestionario de la Diabetes
Hair Loss
Cuestionario de la Caída del Cabello
Hormone
Cuestionario de la Hormona
Osteoporosis
Cuestionario de la Osteoporosis
Pituitary Disease
Thyroid Disease
Cuestionario de la Tiroides

Providence Building, St. Joseph Hospital Campus 1310 West Stewart Drive, Suite 610 Orange, CA 92868
(714) 639-1815