Patient Resources

Clinic intake forms

To help save you time when visiting the clinic, the following PDF forms can be filled out on your computer then printed or emailed to us or filled out by hand for presentation at the time of your visit. Please email forms to customercare@akesomedical.com

El Centro Clinic

COVID

SCREENING

 

COVID Cribado

COVID

SCREENING

 

Fill out /Print     

HEALTH

HISTORY

 

Información del Paciente

HEALTH

HISTORY

 

Fill out /Print     

TREATMENT

CONSENT

 

Consentimiento

TREATMENT

CONSENT

 

Fill out /Print     

MEDICAL

DISCLOSURE

 

Divulgación médica

MEDICAL

DISCLOSURE

 

Fill out /Print     

RECORDS

RELEASE

 

Publicación de registros

RECORDS

RELEASE

 

Fill out /Print     

HIPPA

NOTICE

 

Aviso de HIPAA

HIPPA

NOTICE

 

Fill out /Print     

CANCELATION

POLICY

 

Política de cancelación

CANCELATION

POLICY

 

Fill out /Print     

Huntington Beach Clinic

Irvine Clinic

Napa Clinic

National City Clinic

Oxnard Clinic

Santa Fe Springs North Clinic

Santa Fe Springs South Clinic

Santa Maria Valley Clinic

For more information, please contact us at info@akesomedical.com