Download the forms
- New Patient Packet 2026 (PDF, 10 pages)
- Pain Management Agreement (PDF, 2 pages)
- Consent to Receive Text Messages (PDF, 1 page)
Print, complete and sign, then bring the pages to your visit. The packet is the one every new patient completes; the other two apply only if the office asks you for them.
New Patient Packet
If you are joining the practice, this is the only thing you need. The 2026 packet brings together everything a new patient completes: our notice to patients and what to bring to your first appointment, the no-show policy, the prescription refill policy, the patient registration form, the health history, the TB exposure risk assessment, the HIPAA patient consent, and the financial disclosure statement.
Complete the packet before your first visit and bring it with you, or arrive 30 minutes early and complete it here. Please note the packet has a $50 fee for missed appointments and for cancellations with less than 24 hours' notice.
Patient Registration Form
Your personal details, address and contact numbers, demographic information, insurance information, and your preferred pharmacy, local and mail order. This is also where you tell us you would like access to the patient portal. Just give us a valid email address.
Adult Health History
Four pages covering your medical background: conditions over the past ten years that needed hospitalization or more than two weeks of treatment, injuries, family history, lifestyle, medications, vitamins and supplements, allergies, surgeries, and a head-to-toe review of symptoms. This is the form that gives the doctor the fullest picture of you, so it is worth taking your time over.
HIPAA Compliance and Patient Consent
Sets out how we handle your confidential medical information, lets you name the people who may pick up prescriptions or receive records on your behalf, and records who to notify in an emergency.
Adult TB Exposure Risk Assessment
A short set of yes/no questions about tuberculosis exposure and travel, used to work out whether a Mantoux tuberculin skin test is needed. Often requested for employment, school or care work.
Financial Disclosure Statement
The last page of the packet. It explains how balances are billed, that payment is your responsibility regardless of insurance, and that the office does not accept workers' compensation insurance. Please read it and sign it with the rest of the packet.
Pain Management Agreement
Only for patients who are prescribed pain medication. It sets out how those prescriptions are managed: one pharmacy, refills at office visits during regular hours, no early refills, and periodic testing. Read it carefully, bring your questions, and sign it with the doctor at your visit.
Consent to Receive Text Messages
Optional. Sign it if you would like appointment reminders and office notices by text message. It explains how to stop the messages at any time, and that texting is never used for emergencies or detailed medical questions.
Would you rather have them on paper?
Not everyone wants to print forms at home, and not everyone should have to. Call the office at (951) 303-6158 and we will mail the forms to you or email them, whichever is easier. You are also welcome to pick up a packet from the front desk during office hours.