Forms:

Please print out and complete at your convenience. You can mail the completed packet to the office (2150 Main St, Ste. 3, Cambria, CA, 93428), email (info@coastalpinesmedical.com), or call the office to schedule a time to drop off (805-927-1673). Thank you. We look forward to connecting with you soon!

1 CPMG PT PKT cover sheet 1 copy.png
5 CPMG Pt R&& Attestation 5 copy.png
2 CPMG Communications Form 21 copy.png
6 CPMG Privacy Practices Attestation 6 copy.png
9 CPMG Notice of Privacy Practices 91 copy.png
3 CPMG Patient Intake Form 31 copy.png
7 COASTAL PINES MEMBERSHIP AGREEMENT rev Feb 11 20221 copy.png
10 CPMG PT Rights _ Responsibilities 101 copy.png
4 CPMG Medical Release Form 4 copy.png
8 CPMG Financial Agreement 81 copy.png
11 CPMG  Amenities list and fees1 copy.png