Patient Registration
You may preregister with our Santa Barbara office by printing out the three forms below. One form is your medical history, the patient registration, and our financial policy. Please remember to bring the completed forms with you to your first appointment. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Click here to view and or print our medical history form.
Click here to view and or print our patient registration form.
Click here to view and or print our financial policy.
TECHNICAL NOTE:
PC Users
Our online form use the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.
Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe’s web site.