Follow these instructions:

(1) press down the button “Questionnaire” to open the page of income security.

(2) then fill your name and date, and press the submit button (Submit).

(3) that transports you to a new page that indicates the forms available to choose.

(4) start with the pressing on “Consent for Internet Communications” (Internet communication consent). Fill out and submit.

(5) follow the “Patient Information form” (form of patient information). Fill out and submit.

Note: These forms are many pages. Please use the arrows at the top and bottom part of the page to switch to the other pages and fill out all the requested information before pressing the submit button (Submit). We will ask you your signature when you arrive at your appointment.

6) to serve you better in the future, we ask that please return to this page to fill out the survey of satisfaction with our services “Patient Satisfaction Survey” after his visit.

If there is any change or correction of the information submitted, please call us or can also come to our office (562) 869-0928.

Thank you for your patronage.

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