Upon scheduling your New Patient Consultation, you will be given a User ID and Password, please click on the Green Patient Portal Button to log into the Portal and  order to fill out your medical history and demographic information.  ** DO NOT CLICK ON  “REQUEST  NEW USER ID and PASSWORD”.  The Portal MUST be completed prior to your scheduled appointment date.  Once you enter the portal and agree to the terms, please update the demographic screen and click “Update”.  Next you will see the history form tab located in the upper left in orange.  THIS MUST BE COMPLETED PRIOR to your appointment. Please refer to your welcome email for information on completing the Medical Records Request, Counsyl Waiver, Financial Policy, and HIPAA Notice of Privacy Practices.

If you experience problems with our Portal, please contact our office: 949 642-8727

To download all of our new patient forms as a bundle click here.

Individual New Patient Forms (same forms as in the Welcome Email package)

• New Patient Checklist and Forms
• Carrier Screening
• Email / SMS Correspondence Consent
• Medical Records Release Request
• IDS Patient Notice
• Financial Policy
• HIPAA Notice of Privacy Practices

 

Please contact our office for further information about your appointment.

Please note: To view, complete and print our fill-in PDF forms you’ll need the freely available Adobe Reader software installed on your computer. If you do not have Adobe, click here.