FORMS
Patient Registration
If you are a new patient to our practice, if your contact or any other information has changed, or if you have not come in for over two years, please download this form and bring it in on the day of your appointment.
Download here.
English
Spanish
Staying Healthy Questionnaire
Please download the correct form, fill it in, and bring it with you on the day of your appointment.
Download the correct version of the assessment here.
Authorization for Releasing Your Medical Information to OUR PRACTICE
Please use this form to request that your medical information or records be released and shared with our practice. This can be used to request information from a previous provider, specialist, hospital, or other entity that previously addressed your health needs.
Download here.
Authorization for Releasing Your Medical Information to ANOTHER ORGANIZATION
If you would like us to share your medical information and records with another business, entity, person or provider, please fill out this form and give it to us.
Download here.
Contact
Phone: + (714) 547-6485
Fax: + 714 285 9466
Instagram: @southmainmedical
Facebook: @southmainmedical