Patient Forms

Patients scheduled for an Initial Evaluation with our office are required to bring the following information to their first visit: 

• Completed Intake Packet
• Patient History Review Packet
• Government Issued Photo ID  (Drivers License, Passport, Military ID, Senior Citizen ID, etc.)
• Insurance Cards (Our office is unable to bill your insurance carrier without current copies of your insurance cards) 

We ask that patients arrive no less than 15 minutes prior to their scheduled appointment time, to ensure all paperwork is up to date, and complete. 

PLEASE NOTE: Our office is required by insurance regulations to keep current and accurate patient contact and billing information on file - This ensures no complications will arise should there be a need to prescribe medication, refer you to an outside provider, request additional testing, or submitting claims to your insurance carrier for payment.  

Our office will request an updated copy of our Intake Packet be completed annually. 

Central Coast Renal Care is happy to transmit your records to any of your consulting providers (local providers, or out of the area specialists), as well as forward your records on when moving out of the area, or for any other reason.  Please print and complete the form below and send to our office to process - Be sure to indicate the dates of service you're requesting records for, as well as how you would like your records sent, where they should be transmitted to and/or who is authorized to pick up your records in person. 

Please keep in mind, per the Medical Board of California our office is required to provide copies "within 15 days of receipt of the request." Our office is permitted by the Medical Board of California our office "may charge a fee of 25 cent per page, along with reasonable clerical costs." You will be expected to pay the fee due prior to our office releasing records. No charge will be applicable if records are being transmitted from our office to another providers office.