For appointments, please contact our office or email us at email@example.com
615 Orange, CA
Re-scheduling and Cancellation policy
We understand that our patients’ schedules change. If you would like to cancel or re-schedule your appointment, please give us 24-hour notice in advance. Patient who misses or cancels an appointment with less than 24-hour notice will be responsible for missed appointment fee, payable upon receipt, or at the next appointment.
For our patients who need refills on their medication(s), please contact your pharmacy directly to request for a refill. Since it usually takes 4-5 business days to get a refill, please contact your pharmacy a week before you are completely out of your medication(s). Please contact our office to schedule an appointment for refills of the following: pain medications, anti-depressants, and sleep medications.
*please note we will not replace lost or stolen prescriptions of narcotics or controlled substances.
Notice of Privacy Practices (HIPAA)
This form explains how we comply with Health Insurance Portability and Accountability Act (HIPAA) to protect your personal information. To download the form, click here (include the form in pdf format)
Authorization for Release of Health information and Records
We operate a computer based medical record system and your health information is kept confidential. We request you to fill and sign the Authorization form to release your medical information to any healthcare providers outside our group. We request you to allow 3 – 5 business days to get you the records post the request submission. Please contact our front desk for more information or email at firstname.lastname@example.org
There will be a minimum fee of $40.00 for the completion of any form other than that required by your health insurance for payment to this office for medical services (e.g. FMLA, short- or long-term disability forms). Please allow 1 to 2 weeks for completion of all forms. Fee for for the completion of a handicap parking application is $25.00.