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New Patient Registration

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What To Bring To Your First Appointment

Please Bring the Following to your Appointment at Opsam Health:

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  • Driver’s license, valid passport, or other valid photo identification.

  • If the address on your ID card or driver’s license is not current, you must provide a recent utility bill, bank statement, or rental agreement with your current address,

  • Social Security Card, if applicable (social security number)

  • Health Insurance ID card(s) showing group & policy number, if applicable

  • Medicare and/or Med-Cal card(s), if applicable

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Please provide any information on surgeries, family medical history, past and current health issues, and immunization records. You will need to sign the Medical Release of Information form.

Your First Visit

We welcome you as a new patient to our office.  We appreciate the confidence you place in us as your health care provider, and thank you for choosing Opsam Health.

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New patients can save time during their first appointment by downloading and completing the Patient Registration Form before your visit. Please print and bring these forms to your first Opsam Health appointment.

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New Patient Registration Form [English] [Spanish]

Behavioral Health [Adult] [Adolescent]

Adult (ages 18 and over) [English] [Spanish]

Minor (under 18 years of age) To be completed by parents or legal guardians [English] [Spanish]

 

If you have any questions or concerns regarding patient registration or scheduling an appointment,

please call (844) 200-2426. 

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For Self-Pay

If you don’t have health insurance, please bring proof of income. It will be used to help you enroll in a sliding fee scale.

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Examples of proof of income include the following:

  • Pay Stubs

  • W2

  • Bank Statement

  • Most recently filed tax return

  • Social Security Determination Letter

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If you need assistance in applying for insurance, we can help you through our Certified Enrollment Counselor.

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