Phone: 415-519-2800

Electronic form.  Legible and Complete.  Time Efficient.

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Size of PracticeMonthly PaymentAnnual Payment(Save 15%)
3-10 professionals$99$1,009.80(Save $178.20)
1-2 professionals$49$499.80(Save $88.20)
Large practices/hospitalsAsk ??

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Your monthly fee is covered by reduced staff time with 1-2 new patients per week.

Menu of Forms
We Include for YOU

Standard forms

  1. Patient demographics (incl consent to treat)
  2. Assignment of Benefits
  3. Health screening (allergy, pharmacy, etc)
  4. Health history including meds, surgeries, alt treatments- review of systems
  5. Family History
  6. Social history (education, activity level, tobacco, alcohol use, recreational drugs)
  7. HIPAA form release and disclosure
  8. Office policies and acknowledgements

We welcome your other forms.  Let’s talk!

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