New Patients

Welcome New Patients! I look forward serving you!

General Pediatric Intake Form

General Intake

In an effort to better serve you, please follow the reminder checklist below to prepare for your first visit:

• Fill out and sign all downloadable forms before your appointment. Please fax all forms to 805.565.7776 and bring the originals with you to your appointment.

• Please allow approximately an hour and a half for your first visit and one hour for subsequent visits.

• Please wear comfortable loose fitting clothing.

• Please arrive 5-10 minutes early. This will help you to rest a few minutes enabling your pulses to calm for the visit.

• Please park behind the clinic in our large private lot.

• Payments, in the form of cash, check, Visa or MasterCard are expected at the time services are rendered.

• If you have insurance, please call your insurance company in advance to verify coverage and bring your insurance card with you to your appointment.

• If you need to change your appointment, please provide us at least 24 hours notice.

• Do not hesitate to discuss any questions you might have with me.