Forms
Useful Patient Forms for your appointment
Please select the correct form below and print corresponding PDF. Once printed and filled out, please bring into your appointment.
Please sign forms in presence of office staff the day of appointment
Patient Demographics
Patient information sheet with parents/legal guardians info address, telephone numbers, etc.
Financial Responsibility form
Acknowledgment of Financial responsibility.
Consent for treatment of minor
Authorization for someone other that parents/legal guardian to bring in patient for appointments and/or make medical decisions in the absent of the parents/legal guardians.
ADHD Forms
Additional Forms
ACCEPTED INSURANCE
All additional plans please call our office at 209-544-7300
HMO
Allcare
Gould
Aetna
Blue Cross
Blue Shield
Cigna
Healthnet
United Healthcare
Sutter Health Plus
Health Plan of San Joaquin
PPO
Aetna
Blue Cross
Blue Shield
CBA
Cigna
Healthnet
Partners in Health
Sutter Select
Tricare
United Healthcare
Web TPA
Western Growers
