New Patient Forms

Welcome to our Practice! (the name is pronounced  ” Duke  Doe” ).   Please download the following forms to fill out and mail or fax to us prior  to your first appointment. There are three (3) forms with at least four (4) pages total. The exact number of pages would depend on the particular format of your PC or printer.   Be sure to fill out the ALLERGY/ALLERGIES sections.

520 Superior Ave; Ste. 200   NB, CA 92663 (turn into Hoag Health Center)  MAP   IT  !

Phone: (949) 574-4114      Fax:  949-574-4144

We will try our best  to  obtain your medical information from the referring physicians.  Remember that it may take days to weeks for record to be sent to us. Two days prior to your appointment, you should call us to confirm the receipt of your test results. If necessary, you can download the Release-of-Record form if required by the referring office.

Release-of-Record

Sometimes the best way is to pick up the record yourself and bring it with you to your appointment. Hopefully all doctors’ offices can one day connect both electronically and confidentially!

Please  fax/mail to to us  or bring to  your appointment:

  • The new patient forms (completely filled out)
  • Insurance card
  • An updated list of all your medications or the original labels (including all prescription drugs, vitamins, supplements, herbs, etc.)
  • Any pertinent medical record that you may have
  • An organized log of your glucose testing if you have diabetes

Please note:  If you are late or have incomplete paperwork, you may be asked to reschedule.    Copays are due at the time of service (cash or check only)

Please help us stay efficient by giving us advance notice if you cannot make it to your appointment, either new or follow-up. We wish we never have to impose a charge for the missed appointment

Advertisements