Patient Forms

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form availible for your signature.

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Address: 1745 South Imperial Av, Suite 107 El Centro, CA 92243
Phone: (760) 353-7603

The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. Please feel free to read our HIPAA Complaincy Form in order to feel more secure using online registration forms.




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