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Forms for our patients to fill out.

If you are a new patient to our office you can download these forms to fill out.

If you have insurance you will need to fill out:
  • Confidential Patient form page 1 & 2
  • Patient consent form
  • Insurance Policy
  • Read the HIPAA privacy policy page 1 & 2
If your insurance is covered through American Specialty Health
you will also need to fill out:
  • ASHP Initial authorization form
If you are a Medicare patient:
  • Confidential Patient form page 1 & 2
  • Patient consent form
  • Insurance Policy
  • Read the HIPAA privacy policy page 1 & 2
  • Medicare ABN form
If you are a cash patient you will need to fill out:
  • Confidential Patient form page 1 & 2
  • Patient consent form
  • Financial Policy
  • Read the HIPAA privacy policy page 1 & 2
If you are a returning patient
insured by American Specialty Health
and need additional visits authorized:
  • Followup authorization form
Financial Policy

Insurance Policy

HIPAA Privacy Policy page 1

HIPAA Privacy Policy page 2

Confidential Patient form page 1

Confidential Patient form page 2

ASHP Initial authorization form

ASHP Followup authorization form

Patient consent form

Medicare ABN form

4769 Soquel Dr., Soquel Ca. 95073 (831)462-3350



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