Call 657-800-7179    |    4902 Irvine Center Drive, Suite 105, Irvine, CA 92604

New Patient Forms

Welcome to our practice. We are committed to making your new patient onboarding experience a good one. Instead of waiting in the waiting room to fill out the paperwork, you can read and sign the paperwork prior to your visit.

  • New Patient Form, this is to help us establish your chart.
  • Patient Rights and Responsibility, please read and sign.
  • HIPPA, this is a notice of privacy, please read and sign.
  • Staying Healthy Assessment, this is required by the California Department of Health Services for all Medi-Cal members to fill out within 120 days of becoming a Caloptima member.
  • Patient Portal Instruction, we provide a patient portal for free messaging with office staff, appointment scheduling, download and sharing lab result, sharing each visit diagnosis and treatment plans. For paid services of house call, video visits, and phone visits.
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