Patient Forms and Resources

NEW PATIENTS / Patients Not seen in Last 3 years


Welcome to our Practice! Thank you for choosing us to be part of your healthcare. 

We are a Veterans Choice clinic. If you are already enrolled in VA health care, the Choice Program allows you to receive health care within your community with Veterans Choice Clinics. 

To schedule a Veterans Choice Program appointment you must call 866-606-8198. ​ 

We Accept Most PPO insurances , Medicare Part B, Multplan Insurances and are part of Hill Physicians network. 
​Please call our OFFICE at 510-582-6424 to check on insurance eligibility. 

Plan to arrive 30 min before your appointment. We also request that you bring a copy of your insurance card(s). The insurance will be verified at the time of your appointment. We ask that you bring with you either a list of your medications - including the dosage - or your actual pill bottles. 

Please Provide all requested information for the Patient and the Subscriber in the form to speed up the eligibility and insurance verification process. Date of Birth, Insurance card and State issued ID card is required for Patient and State issues ID card is required for the Responsible Party. Please Fill out and sign  the required Form to Speed up the registration process.

To ensure that your first visit goes smoothly, we request you fill the forms below. Please Fill the Form either using Acrobat on your computer and then print and Sign OR Print the Blank Form, use Upper case letter to print all information in the form legibly and Sign and bring it with you at the first appointment. Please make sure to fill and Sign all the form in the list below to avoid delays during your visit and issues with insurance payments. ​

New Patients will only be seen after insurance eligibility is verified.  For Saturdays and  after 5 PM on Extended Hour days Please call our office at least 48 hours in Advance to make sure the insurance eligibility has been verified before you arrive for the appointment

Established Patients / Patients Seen At-least Once in Last 3 Years


We Request Our Existing Patients to Sign the Updated Assignment of Benefit , HIPAA Notice of Privacy Form every year . Also Please provide any changes in your insurance and Responsible Party status using the Patient Registration from below. Correct Insurance information helps us to expedite our billing and to provide the best  support for your Health Care Needs.


For any Paper Forms please allow  1 week from the time of request

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