Patient Forms

Before Every Visit

All patients should complete the COVID Supplemental Health Questionnaire before every appointment. Please complete and submit this form using your smartphone while you wait in the parking lot prior to your scheduled appointment time. When you have submitted both forms, text the patient’s full name to 831-475-5500, and our team will provide additional instructions.

  1. COVID Supplemental Health Questionnaire – English (No More Than 12 Hours Before Each Appointment)

  2. COVID Supplemental Health Questionnaire – Spanish (No More Than Hours Before Each Appointment)

First Visit Patient Forms

We ask that all new patients complete our New Patient Health History form online prior to their first appointment. Once completed, save the form and email it to us at (You will need the free Adobe Reader to use our forms.) Completing your form now will save you time in the office and allow our staff to have your form printed out and ready to review when you or your child arrive at the first appointment.

Additionally, we request all patients complete and submit the COVID Informed Consent Form prior to the first appointment following our re-opening date. This form only needs to be completed once.

  1. Child Health History Form

  2. Child Health History Form – Spanish

  3. Adult Health History Form

  4. Adult Health History Form – Spanish

  5. HIPAA

  6. HIPAA Acknowledgement

  7. Sleep Questionnaire

  8. COVID Supplemental Informed Consent Form (Only Complete Once)

  9. COVID Supplemental Health Questionnaire (No More Than 12 Hours Before Each Appointment)

  10. Informed Consent – Spanish

  11. Sleep Questionnaire – Spanish

  12. Supplemental Health Questionnaire – Spanish

Please contact our office if you have any questions regarding these forms.