Patient Forms

To save time on the day of your appointment, please fill out these forms and bring them with you:

Prescription Refills

Please call one of our fourteen locations with the following information:

  • Practitioner's Name
  • Name of Medication
  • Pharmacy Name
  • Pharmacy Phone Number
  • Date of Last Refill

For narcotics such as Percocet, MS Contin or Oxycontin, plan to either come into the office for a written prescription or allow five days for the written prescription to be mailed. By law, your pharmacy must have a written prescription. Narcotic prescriptions cannot be written on weekends.

Insurance And Billing

If you are a new patient, you will fill out an insurance profile and discuss your options with us. We will make a copy of your insurance card(s) for your file. Remember to contact the office at any point during your care if there is any change in your coverage.

Patients belonging to an HMO, POS or PPO must verify with their provider(s) that we are on your plan. It is also your responsibility to obtain the initial referral and bring it with you and to inform our office staff if you require pre-certification for admissions, treatments or tests.

We participate with most major insurance companies and will submit claims on your behalf. Please indicate primary and secondary carriers on your insurance profile if you are covered by more than one company. We also accept Medicare, although you will be responsible for the deductible and co-payment for physician care, chemotherapy medications and laboratory tests.

Co-payments are due at the time of your visit. We accept Visa, MasterCard, Discover and American Express. We will be happy to assist you in developing a payment plan.

Our staff will be happy to help you with any questions you may have.

We accept the following insurances:

  • Access
  • Accountable Health
  • ADOC (Affiliated Doctors of Orange County)
  • Advantage Care
  • Affiliated Physicians IPA
  • Allcare Medical Group
  • Allied Medical Group
  • Altamed Medical Group
  • AMVI
  • Angeles IPA
  • Applecare Medical Group
  • Associated Hispanic IPA
  • Avante Best Care
  • Bella Vista IPA
  • Brand New Day IPA
  • Bright Health Physicians
  • Brookshire IPA
  • CalCare IPA
  • Care 1st
  • Caremore Medical Group
  • Central Health IPA
  • Community Family Care
  • Doctor's Choice Medical Group
  • Esperanza Medical Group
  • Employee Health System IPA
  • Family Care Specialists
  • Fenix Medical Group
  • First Choice IPA
  • Future Care IPA
  • Genesis IPA
  • Global Care Medical Group
  • Good Samaritan Medical Group
  • Healthcare Partners
  • Healthcare LA
  • Hispanic Physicians IPA
  • Imperial Health Holdings Medical Group
  • Lakeside Medical Group
  • MaxiMed IPA
  • Medichoice IPA
  • Molina Medical Group
  • Monarch Healthcare
  • Nuestra Familia Medical Group
  • Omnicare Medical Group
  • One Care
  • Physicians Associates
  • Physicians' Healthways
  • Pioneer Medical Group
  • Preferred IPA
  • Prospect Professional Care
  • Regal Medical Group
  • Starcare IPA
  • Seoul Medical Group
  • Talbert Medical Group
  • Watts Healthcare
PPO / Private
  • AARP
  • Aetna
  • Blue cross
  • Blue shield
  • Cal Optima
  • Central Health
  • Cigna
  • Citizens Choice
  • Choice Care
  • Coventry
  • Greatwest
  • Health Net
  • Humana
  • Medicare
  • Medi-cal
  • Multiplan
  • Operating Engineers
  • PacifiCare
  • Secure Horizons
  • Southwest Administrators
  • The Reta Trust
  • Tricare
  • Triwest
  • Unified Grocers
  • United Healthcare
  • Aetna
  • Alignment Health
  • Blue Cross
  • Blue Shield
  • Chaffey Medical Group
  • Cigna
  • Crown City
  • IEHP
  • Elite Medical Group
  • First Health Network
  • Family Health Alliance
  • Healthcare Partners
  • Health Net
  • Healthsmart
  • Inland Empire Health Plan
  • Korean America Med. Group
  • Maverick Medical Grp
  • Networks By Design
  • Noble Community
  • PacifiCare
  • Railroad Medicare
  • San Miguel
  • Salud E Mas
  • Scan
  • South Atlantic Medical Group
  • Secure Horizon
  • Superior Choice
  • Universal Care/ Edwards IPA
  • United Physicians International
  • United Care Medical Group (UCMG)
  • United Healthcare
  • Scan Health Plan (managed by UHC)
1700 E. Cesar Chavez Ave. Suite 3750
Los Angeles
United States