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New Patient Forms

To save time on the day of your first appointment, please complete these forms in advance and bring them with you.

PATIENT REGISTRATION FORM: Please fill out both pages

MEDICAL RECORD REQUEST FORM: We will send a fax request to obtain your medical records

If you are unable to complete the forms in advance, no problem—we have them available to fill out at our office.

Insurance & Billing

Accepting Most Insurance Plans

Some major plans we accept:

  • Aetna

  • Blue Cross/Blue Shield

  • Healthnet

  • Valley Health Plan

  • Cigna

  • United Healthcare

  • Santa Clara Family Health Plan

  • Alignment

  • Brand New Day

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*If you have an HMO Plan, please make sure that one of our doctors is listed as your PCP*

Not Sure If We Take Your Insurance?
Give us a call at 408-550-2981 or 408-935-9586 to schedule your appointment, and we'll be happy to confirm if your insurance is accepted and answer any other questions you may have.

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Payments

Please note that a 3% service fee will be applied to all credit card transactions. To avoid this fee, we recommend paying by check or cash.​

 

*Please be prepared to pay any applicable copay at the time of your visit.*

What to Bring

  • Insurance Card(s)

  • Any medical records you have 

  • List of current medications

  • Patient Registration Form & Medical Record Form

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