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Patient Enrollment 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 (, or call the office to schedule a time to drop off (805-927-1673). Thank you. We look forward to connecting with you soon!

Copy of 0- Cover Sheet.jpg
Copy of 1- Membership Benefits_Page_1.jpg
Copy of 2- Fee Schedule.jpg
Copy of 3- Membership Agreement_Page_1.jpg
Copy of 4- Financial Agreement_Page_1.jpg
Copy of 5- Payment Information.jpg
Copy of 6-Patient Medical Intake_Page_1.jpg
Copy of 7-Patient expectations_Page_1.jpg
Copy of 8a- Patient Rights _ Responsibilities_Page_1.jpg
Copy of 8b- Pt R_R.jpg
Copy of 10-Medical Release Form.jpg
Copy of 9a-Notice of Privacy Practices_Page_1.jpg
Copy of 9b- Privacy Practices Attestation.jpg
Copy of 11- Release of med info to family.jpg
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