PATIENT FORMS

If you would like to give us some feedback on our service and to comment on those areas that you feel were exceptional and those below par, please take the time to fill out our survey or leave your thoughts in our testimonial section. 

On a scale of 1 to 10, with 10 being best please rate the following categories. 

For your convenience, patient forms are available for download on our website. To help speed up your first visit, please download, print, and complete the necessary forms ahead of time and bring them with you. If you prefer to fill out the forms at our office, please arrive 10–15 minutes early to allow sufficient time before your appointment.

If you are a new patient scheduling your first appointment, review the list of required forms below and bring them along with a photo ID and a copy of your insurance card—unless you are paying cash.

* Direct Access Disclaimer: Required only if you do not have a doctor’s referral.

** Lien Form: Only needed if you were referred by your attorney and your case involves a lien.

*** Patients will receive text message reminders. We respect your privacy—no mobile information is shared with third parties or affiliates for marketing or promotional purposes. Consent for text messaging is managed separately, and no opt-in data is shared.

Patient Survey

Patient Testimonial

Downtown Clinic

5300 California Ave. Suite 110
Bakersfield, CA 93309
 
Monday – Friday:
9 AM – 6 PM
Saturday & Sunday:
Closed
 
Phone: (661) 631-8793 x1

Northwest / Aquatic Center

3850 Riverlakes Dr Suite A
Bakersfield, CA 93312

Monday – Friday:
9 AM – 6 PM

Sunday: 9am to 4pm
Saturday Closed:

Phone: (661) 529-2303 x1

Downtown Clinic

5300 California Ave. Suite 110
Bakersfield, CA 93309
 
Monday – Friday:
9 AM – 6 PM
Saturday & Sunday:
Closed
 
Phone: (661) 631-8793 x1

Northwest / Aquatic Center

3850 Riverlakes Dr Suite A
Bakersfield, CA 93312

Monday – Friday:
9 AM – 6 PM

Sunday: 9am to 4pm
Saturday Closed:

Phone: (661) 529-2303 x1