Dedicated to a Higher Standard of Care

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Forms

 

These Various forms are in PDF format for viewing, downloading and printing.

New Patient Pack

Dear New Patient

Health Questionnaire

Patient Information Form

Payment Plan Form Letter

Medication List

Patient Partnership Plan 

Medical Forms

Post-operative Patient Instructions, Major Surgery

Post-operative Patient Instructions, Minor Surgery

A Patient’s Bill of Rights

Privacy Practices

Advance Health Care Directive

Authorization for Use and Disclosure of Medical Information

Gardasil Purchase Agreement

EDD Disability Forms


  • DR. PAULA’S BLOG
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  • GYNECOLOGY
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  • SPA
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Specialty Care & Surgery Center

5685 Main Street, Kelseyville, CA 95451

T: 707-279.8733

F: 707.279.8731

info@dr-specialtycare.com