Patient Guide
Before your visit
If you are an existing patient and have an appointment for a new service, please fill out the form for the service you will be receiving at your next appointment.
Provide the following for the day of your visit
- Health Insurance Identification Card
- Photo Identification (State ID, Drivers License, Passport, etc.)
- List of medications you are currently taking
Forms
Primary Care (supplemental)
English | Korean | Spanish | Chinese
Dental (supplemental)
English | Korean | Spanish | Chinese
Behavioral health / psychiatry / therapy / mat (supplemental)
English | Korean | Spanish | Chinese
CalAIM Forms
Health needs assessment
English | Korean | Spanish | Chinese
Housing intake
English | Korean | Spanish | Chinese
Agency third party homeless verification
English | Korean | Spanish | Chinese
At risk of homelessness verification
English | Korean | Spanish | Chinese
Disabling condition verificiation form
English | Korean | Spanish | Chinese
Self certification of homelessness
English | Korean | Spanish | Chinese
Forms
Patient satisfaction survey
English | Korean | Spanish | Chinese
patient complaint survey
patient feedback form
NOTICE TO PATIENTS OPEN PAYMENTS DATABASE
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospital be made available to the public.
You may search this federal database for payments made to physicians and teaching hospitals by visiting this website: