Initial Visit Form

Please print and complete this form prior to your initial visit. Also, please remember to bring a current photo ID and insurance card.

INSURANCE

We accept a variety of insurances, including:

  • Medicare, Medical / Cal-Optima
  • Alta-Med
  • Memorial Care Medical Group
  • Arta Medical Group
  • PPOs
  • Blue Cross of California
  • Blue Shield of California
  • Cigna Health Care
  • Tri-west
  • Health Net
  • United Healthcare
  • Aetna
  • Beach Street
  • Unitedcare Medical Group
  • Prospect Medical Group
  • St. Joseph Heritage
  • Worker’s Comp

If you do not see your insurance above, please contact us for clarification. We also accept cash-based payments to serve patients in which insurance is an issue.

Payment Methods accepted: