Initial Visit Form

 Initial Visit Form

Please print and complete this form prior to your initial visit. Also, please remember to bring a current photo ID and insurance card.

Insurance

We accept a variety of insurances, including:

• Medicare, Medical / Cal-Optima
• ADOC
• Regal Medical Group
• Alta-Med
• Memorial Care Medical Group
• Arta Medical Group
• PPOs
• Blue Cross of California
• Blue Shield of California
• Cigna Health Care
• Tri-west
• Health Net
• United Healthcare
• Aetna
• Beach Street
• Unitedcare Medical Group
• Prospect Medical Group
• St. Joseph Heritage

If you do not see your insurance above, please contact us for clarification. We also accept cash-based payments to serve patients in which insurance is an issue.

Payment Methods accepted: Cash, Personal Check, Visa / MasterCard
 

Note: To download Adobe Acrobat Reader for free, click here.