Do the following steps once you have called the office to secure an appointment time.
1. Download and fill out the following forms:
2. Once the forms have been filled out and saved, email all documents to firstname.lastname@example.org.
The following documents must be attached in the email:
3. Wait for an email confirmation that everything has been received. If you do not receive confirmation within 24-48 hours, please call the office at (408) 245-3574. Operating hours may vary due to COVID-19.
If you have Medicare insurance, please fill out BOX-12 ONLY on the Medical Insurance Form.
Only your signature and signature date is needed. All of the other information will be extracted from your intake forms.
Please include this form in the email along with the other documents required to finalize your scheduled appointments.