Thank you for choosing Heart Vascular and Leg in Bakersfield, California. Please use the links below to download our new patient forms. We ask that you complete the forms prior to your first visit to help expedite the registration process.
New Patient Form (English)
New Patient Form (Español)
There are 9 pages included in our New Patient Form Packet. This includes:
- Patient Information Form – includes your insurance information for us to register you with our practice.
- Physician-Patient Arbitration Agreement
- Patient Rights & Responsibilities
- Ownership Disclosure
- Medical Records Request/Release
- Consent Form for Use of Photographs, Videos & Personal Medical Information
Medical Treatments Authorization Form for Minor (English)
Medical Treatments Authorization Form for Minor (Spanish)
Please also bring the following documents to your first visit so we can make copies for our records:
- A photo ID such as a Driver’s License, State ID, Military ID, etc.
- Your current insurance cards
- Your referral slip from your Primary Care Physician (if required by your insurance plan)
If you are a returning patient, please:
- Bring a photo ID such as a Driver’s License, State ID, Military ID, etc.
- Bring your referral slip from your Primary Care Physician (if required by your insurance plan)
- Notify us of any changes to your insurance information. Notify your doctor of any changes to your health or medications
If you have any questions, please call our office at 661-324-4100