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 information sheet with parents/legal guardians info address, telephone numbers, etc.
Financial Responsibility form
Acknowledgment of Financial responsibility.
Financial Responsibility Form-English
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.
Consent for treatment of minor-English
All additional plans please call our office at 209-544-7300
Sutter Health Plus
Health Plan of San Joaquin
Partners in Health