Southern California Endocrine Medical Group, P. M. C.

1310 W. Stewart Dr., Suite 215, Orange, CA    Office:  714-997-5000   Fax: 714-997-5300 

Registration forms (For new patients)
New Patients only:

A)  Please print out forms #1-4 below, fill in as much information as possible, sign, and bring them with you to your appointment.  (If you are unable to do so then please arrive 30-45 minutes earlier than your appointment time)

B)  Please also bring the following to your first visit:

      *  ID Card or Drivers license card (Required on 1st visit)
      *  Insurance or Medicare Card  (Required on 1st visit)
      *  Your medications
(or a list of your medications, doses, and frequency)
Recent lab reports 
      *  R
adiology reports
and glucometer or blood sugar log book (if applicable).

C)  New patient Registration Forms Clinic_Registration_2014.pdf
1.1 MB
  (Please print and fill out prior to your appointment)

Please give at least 24 hours notice if you need to cancel or to re-schedule your appointment.

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