Ob and Gyn Forms Packets

Records Request (records to us)

This form can be filled out and sent to any physician or hospital that has records that you would like copied and sent to us. Use this for any medical care you might have obtained prior to seeing us that you think we should review.

Records Copy Form (records from us)

You can have a copy of your medical records sent either to yourself or to a designated provider. Records can be sent by paper or electronically or on a thumb drive (extra fee for this).

Fill out this form, sign and date it, and then mail (or e-mail) it to us. There is a $30 one-time fee to cover staff time and materials used.

HIPAA Privacy Notice

A copy of this HIPAA PRIVACY NOTICE is given to all new patients at their initial visit (or is presented to you during digital pre-checkin). In compliance with the federal law known as HIPAA, it describes in detail what we may or may not do with your private (protected) health information (PHI).

California State Disability (SDI)

This form is used to apply for California State Disability (SDI) benefits. DO NOT submit this form until you have STOPPED working. Then fill out your portion including the last day that you worked. After that, give us the form (or send it) and we will complete it and file it for you.

Your SDI disability claim can also be done online.

Tutorial for online EDD claims