WellSpring Medical Group
45 Castro Street     Suite 423
San Francisco, CA   94114
 

Office:   (415)   551-9758
    Fax:   (415)   437-5434

  Business Hours: Monday - Friday
9:00am - 5:00pm

New Patient Forms

We usually request that a new patient arrives for their first appointment, approximately 30 minutes ahead of the scheduled time, in order to complete the necessary new patient paperwork.

To speed this process even more, you may print out the five forms below and complete them before arriving at your appointment.

      Patient Information
      Billing Policies
      HIPAA Consent Form
      Patient Self-Determination Form
      Health Questionnaire

Please read each form carefully, print clearly, and follow all instructions. If you have questions or have problems with filling out any of the forms, bring the forms with you and we will answer any questions you may have.

Medical Records Release Form

Occasionally, a person may want a copy of their medical records released for various purposes:

• Transferring records from a previous doctor

• Transferring records to a new doctor or specialist

• Requirement for getting certain types of insurance
   

In order to release your medical records (or request them from a previous doctor), we must first have a signed authorization by the patient or guardian. Print out and complete the "Authorization for Release of Medical Records" form below:

      Authorization for Release of Medical Records

Return the completed form to this office in person, by mail, or by fax. The turnaround time for sending or receiving the medical records may be from 2 to 6 weeks. Depending on the type of request, there may be a fee charged for this service.

If you have questions or have problems with filling out the form, contact us, and we will answer any questions you may have.

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