10787 Laurel St. Rancho Cucamonga, CA 91730

Mon – Thurs. 8AM-5PM | Friday 8AM-3PM

(909) 982-7741

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Patient Forms & Policies

Printable Patient Forms

For your convenience, you may print out and complete the following prior to your visit:

Patient Registration Forms:

Authorization for Release of Medical Records

HIPAA Release of Information and Acknowledgement HIPAA receipt

HIPAA Information, Rights and Our Responsibilities pages 1-3

Patient Forms & Authorization Releases

Physician Orders for Life-Sustaining Treatment (POLST)

Advanced Health Care Directive

Policies:

Financial Policies

Appointments, Forms, Medical Records and Rx Refills

Procedures:

How to Navigate the Patient Portal

Online Patient Packet

For your convenience, you may complete the entire patient packet and the following prior to your visit online (instead of printing it, this option allows you to fill out your information directly online).

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