New Patients

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
      * Radiology 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.