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We ask that you fill out the necessary forms before coming in for your appointment. Please click on the links below to fill out the forms online, then print them out and sign each one. This will greatly facilitate the processing of your information before your appointment.

 

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New Patient Form

Informed Consent

Financial Policy

HIPAA Notice of Privacy Practices

Formulario para pacientes nuevos

Autorización para tratamiento

Poliza Financiera

Aviso de Practicas de Privacidad

 

Any additional necessary forms will be completed at the office.

 

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info@pachecomedina.com
(805) 687-1106