New Patient Forms

Please click on each form to view a printable version.
All patients new to the Menlo Park office should bring a completed copy of each form with them to their first office visit.


 

Notice of Privacy Practices Form

This form must be signed one time only by all patients to comply with the requirements created by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

See: (Notice of Privacy Practices) .  Please print the form and fill out.  Please bring the completed form to your first visit.

 

First Visit Information

Please read this information before your first visit.

New Patient Health Questionnaire

If you have not previously seen either Dr. Virmani or Dr. Tsung at our Menlo Park office, please print the form and fill out.  Please bring the completed form to your first visit.

 

New Patient Registration Form

If you are new to the Menlo Park office (even if you have seen Dr. Tsung or Dr. Virmani before), please print the form and fill out.  Please bring the completed form to your first visit.

 

Medical Records Release Form

If you are new to the Menlo Park office, please use this form to request a copy of your records from your prior physician.  Even if you were a patient of Dr. Tsung or Dr. Virmani at the Palo Alto Medical Foundation, please still request a copy of your records be sent to our Menlo Park office.

 

Patient Financial Responsibility Form

This form must be signed by all patients. Please print the form and fill out.  Please bring the completed form to your first visit.

 


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