Thank you for choosing our practice as your primary care. We look forward to taking care of all your healthcare needs and to help you achieve your optimal health.
Most of our forms are sent electronically, with the exceptions of the ones shown here. If you did not find what you need, please use the “message us” feature of the website to do a real-time chat with us. Or you may text message us at 916-983-8868.
New Patient Forms
Please download and fill out the New Patient Registration Form and the Patient History Form below. Bring the completed forms on your first visit to minimize your wait time.
- Medical Patient Form in Spanish (PDF)
- If you did not receive already receive an English version, text message us at 916-983-8868.
On your first appointment, kindly arrive 30 minutes before your appointment time to allow time for processing your paperwork and for our physicians to review them before seeing you.
Remember that our office always reserves same-day appointment slots for our patients. If you have any urgent issues that need a doctor’s attention, please call us and we’ll get you in. Avoid the high cost and impersonal environment of the ER or the Urgent Care.
Assessment Questionnaires
- Annual Physical Questionnaire
- Annual Wellness Exam (AWE) Questionnaire
- Alcohol Use Questionnaire
- Epworth Sleepiness Scale Questionnaire
- Well Child Questionnaire for Parents 2-3 years old
- Well Child Questionnaire for Parents 4 years old
- Well Child Questionnaire for Parents 5 years old
- Well Child Questionnaire for Parents 6-8 years old
- Well Child Questionnaire for Parents 9-11 years old
- Well Child Questionnaire for Parents 12-17 years old
- Well Child Questionnaire for PATIENT 11-17 years old
- Developmental Assessment 24 months
- Developmental Assessment 3 years
- Developmental Assessment 4 years
- Developmental Assessment 5 years
- Developmental Assessment 6-8 years
- Developmental Assessment 9-11 years
- Developmental Assessment 12-18 years
- Pediatric Risk Assessment 2-4 yrs
- Pediatric Risk Assessment 5 yrs
- Pediatric Risk Assessment 6-8 yrs
- Pediatric Risk Assessment 9-11 yrs
- Pediatric Risk Assessment 12-18 yrs
Pain Management Policy
Due to the opioid addiction and overdose epidemic in the United States, regulations that govern the prescription of opioids has been severely tightened for the safety of patients. As a primary care clinic, our doctors do not have the expertise to manage patients with severe chronic pain. We depend on the expertise of pain management doctors to manage such patients. Doctors are under tremendous pressure to do our part to curb the opioid epidemic in this country. As a practice, we can no longer prescribe strong narcotics, specifically Hydromorphone, Fentanyl Patch, MS Contin, or high doses of Oxycodone. Additionally, we cannot take over any narcotic pain medication prescriptions from other doctors. We can see new patients for any other conditions, but we cannot take over the manage of strong narcotics pain medication. There are no exceptions.
As an established patient, if you develop conditions that requires chronic opioid pain medication, we will require you to sign an opioid treatment contract and also follow all our office policies and treatment recommendations regarding your condition. These policies are strictly enforced for the safety and health of our patients. These policies do not apply to acute conditions or other classes of pain medication.
- Opioid Treatment Contract (DocuSign Form)
- Consent for Use of Benzo (DocuSign Form)
- Consent for Use of Stimulant (DocuSign Form)
- Alternative Pain Treatment Fact Sheet
- What You Need To Know About Opioids
- Pain Questionnaire
- Pain Management Screening Questionnaire
Other Forms
Weight Clinic Forms
Patients must complete the New Patient Registration prior to your first visit. This is very important and will ensure a smooth first visit.