New Patient Forms

New Patients

Accepting New Patients, we welcome you to Family Health & Medical Services!

The health and welfare of your loved ones is of utmost importance to you. We understand this and will do everything we can to give you the personal attention you deserve. We strive to provide excellent service by getting to know you and your family so we can serve your medical needs effectively.

For further assistance or to make an appointment, call our New Patient Hot Line: 858-565-6394.

To have a relaxed and seamless appointment, please read and fill out the appropriate forms below and bring it to your first visit with the doctor.
    • New Patient Registration
    • Adult Medical History Form
    • Preventative Insurance Waiver Agreement
    • Office Policy on Managed Care Insurers

    • Pediatric Medical History Form
    • Medical Procedures for Minors
    • Medical Liability Release for Minors

    • Notice of Privacy Practices for Protected Health Information
    • Acknowledgement of Receipt of Notice of Privacy Practices
    • Authorization of Disclosure of Protected Health Information

Family Health & Medical Services accepts a large selection of insurance providers. Check with your insurance company to get a listing of participating providers and read about the types of health insurance Policies available.

Location
Associates in Family Medicine
5222 Balboa Avenue, Suite 31
Clairemont

San Diego, CA 92117
Phone: 858-565-6394
Fax: 858-999-2006
Office Hours

Get in touch

858-565-6394