New Patient Form
We highly encourage all new patients to download the six (6) forms below and bring the completed forms to your new patient visit. You will also be asked to present your insurance card and a picture I.D. Thank you in advance for your cooperation.
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Completed forms may also be sent in advance of your patient visit by Email or Fax.
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Fax Completed Forms to: (661) 748-1815
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Email Completed Forms to: info@jasleenduggalmd.com
Nosotros altamente recommendamos que todos nuestros nuevos pacientes bajen estas formas abajo y traerlas completas a su cita para Nuevo Paciente. Favor de presentar tu carta de aseguranza y su indetificacion.En advance le damos las Gracias por su coperacion.
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Formas Completas tambien pueden ser mandadas en advance por via correo electronico o via Fax
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Fax formas completas a : (661)748-1815
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Correo electronico para formas : info@jasleenduggalmd.com
FORMS FOR DOWNLOADING/FORMAS PARA BAJAR:
DOWNLOAD – REGISTRACION DEL PACIENTE
DOWNLOAD – PATIENT REGISTRATION
DOWNLOAD – NOTICE OF PRIVACY PRACTICES
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