Patient Forms
Important:
if you have health insurance coverage through American Specialty Health, please click here here
New patients can download the patient history form and bring the completed form to the initial visit. If you are unable to download and print out this form then you will need to come to the office 15 minutes before your scheduled appointment. Please call 805 403 2188 if you have any questions regarding the form:
- Patient Health History MicroSoft Word format (.doc)
- Patient Health History Adobe Acrobat format (.pdf)
You may also wish to review our Notice of privacy practices, which describes how we protect your health information:
- Notice-of-privacy-practices Adobe Acrobat format (.pdf)