For Patients

 

• Patient Forms
• Map / Directions
• Billing
• Prescription Refills
• Procedure Prep Instructions
• FAQ's
• Patient Portal Login

For questions or to make an appointment, please contatct us: (831) 375-3577
Temporary Phone Hours: 8:30 am - 5:00 pm  / Closed between 12:00 pm - 1:00 pm

Temporary Business Hours: Monday - Friday: 8:30 am - 3:00 pm

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For Your Appointment 

• Arrive 15-30 minutes early to your appointment for registration.
• Bring your original insurance card(s). We will need to make a front and back copy for your record.
• Late arrival or incomplete paperwork could result in your appointment being rescheduled.

Please be aware there is a $50 penalty for a missed office appointment with less than 24 business hours notice and a $200 penalty for a missed procedure appointment with less than 48 business hours notice.

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Patient Forms

We ask that you please print forms front side only. 

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it. 

TELEHEALTH ONLY

• Telehealth New Patient Forms - Fill forms out completely. They will be reviewed prior to scheduling.
• Medicare Form - Please sign if MEDICARE is your primary insurance.

 

DR. MICHAEL LE PATIENTS ONLY 

• New Patient Packet
• Medicare Advance Beneficiary Notice (ABN)  - Please print and sign if MEDICARE is your primary insurance
• Las Formas en Espanol

 

ALL OTHER PATIENTS

• New Patient Packet
• Medicare Advance Beneficiary Notice (ABN)   - Please print and sign if MEDICARE is your primary insurance
• Las Formas en Espanol

 

HEALTH INFORMATION PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA)
As required by HIPAA and California law, this practice may not use or disclose your individually identifiable health information except as provided in our Notice of Privacy Practices without your authorization.  

• HIPAA / Notice of Privacy Practices
• Consent to Disclose Medical Information (In order for our office to discuss your medical/billing information with anyone other than you, the patient; this form must be completed, signed, and handed to our office staff prior to any communication.)
• Medical Records Release (Please complete this form if you need our office to release or request your medical records.)

 

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Map and Directions to Facilities

• Map
• Please scroll down for Door-to-Door directions

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Driving Directions (Door-to-Door)