Open 7 Days a Week

(714) 635-6400

Our Locations

We are available in 7 cities
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    • Notice of Privacy Practices

      I hereby acknowledge that I received a copy of this medical practice’s Notice of Privacy Practices. I further acknowledge that a copy of the current notice will be posted in the reception area, and that a copy of any amended Notice of Privacy Practices will be available at each appointment.

      If not signed by the patient, please indicate relationship:

      Consent for Medical Treatment

      I,
      give permission to

      for treatment including medications and others medical procedures, I understand that I’ll be treated by the medical director and/or physicians assistants.

      Patient’s Signature


      (If the patient is minor, signs the parent or tutor)