Patients Forms

Patient Forms

We offer important information to our new patients that may alter health behaviors or improve their health status. You can save time at your first appointment by downloading and completing our new patient forms prior to your arrival.

Download New Patients Package

Prior to your first visit:

Please read, complete and bring the enclosed forms, along with your insurance card, with you on your first visit.

Please plan to arrive 15 minutes before your scheduled appointment time. If available, please also bring the following:

• Copies of any medical history and lab work.
• List of your present medications and dosage amount.

Individual Patient Forms

Welcome to Our Practice New Patient Information Notice Of Privacy Practices

Health Questionnaire Permission to Relay Information Billing Policy Acknowledgement of Receipt of Privacy Practices

Other Forms

Advance Directives Form Application for Handicap Placard

State of California Disability Form Family Medical Leave Request

Our Office and Location

Our Patients Say It Best

I needed a new doctor when I moved here 5 years ago. Dr. Nili was a good first choice, he asks about your life so he can tailor his care to your activities, traveling, and make adjustments to your diet and habits to keep you healthy. Recently, he discovered my diet of burritos and korean bbq every day was killing me, now I am back on track to being healthy again. Without his kind approach and investigative method to discover my bld sugars and Bld pressure, I might have continued down a dangerous path. As mentioned, his nurse, Liz is great, she stays involved and cares just as much.

AMRIVLIN

Dr. Nili exemplifies how a family doctor should be. He is friendly, approachable and most important care about his patients. He goes beyond treating symptoms, he takes time to investigate the cause and explains not only the short term treatment but also the changes in patient behavior that will help prevent the reoccurrence of the symptoms. He is a rara avis nowadays.

GABRIELAILEANA

He is very professional, knowledgeable and helpful. The office is very clean and organized. The assistants are very nice and professional too.

HSIN-TIEN C.

Patients Forms

Patient Forms

Prior to your first visit:

Alan Nili, D.O. Family Practice

Medical Services

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