Telemedicine options available. Schedule now. Learn more about our COVID-19 response.

Patient Forms


 

NEW PATIENTS

Thank you for choosing Heart Vascular and Leg Center in Bakersfield, California. All Patient forms are all done electronically. You will receive an email with patient form information prior to your appointment.

 

Included in the New Patient Form Packet:

There are 9 pages included in our New Patient Form Packet. This includes:

  • Patient Information Form – includes your insurance information for us to register you with our practice.
  • Physician-Patient Arbitration Agreement
  • Patient Rights & Responsibilities
  • Ownership Disclosure
  • Medical Records Request/Release
  • Consent Form for Use of Photographs, Videos & Personal Medical Information

Medical Treatments Authorization Form for Minor (English)

Medical Treatments Authorization Form for Minor (Spanish)

Please also bring the following documents to your first visit so we can make copies for our records:

  • A photo ID such as a Driver’s License, State ID, Military ID, etc.
  • Your current insurance cards
  • Your referral slip from your Primary Care Physician (if required by your insurance plan)

RETURNING PATIENTS

If you are a returning patient, please:

  • Bring a photo ID such as a Driver’s License, State ID, Military ID, etc.
  • Bring your referral slip from your Primary Care Physician (if required by your insurance plan)
  • Notify us of any changes to your insurance information. Notify your doctor of any changes to your health or medications

If you have any questions, please call our office at 661-324-4100

PROCEDURE PATIENTS CLICK HERE

Location
Heart Vascular and Leg Center
5020 Commerce Drive
Bakersfield, CA 93309
Phone: 661-230-9343
Fax: 661-377-2892
Office Hours

Get in touch

661-230-9343