Patient Forms
Medical Intake Form
Medical History
Authorization for Release of Medical Records
SkinPen Patient Consent Form
New Patients
For your first visit, please bring your insurance card and arrive 15 minutes early to ensure all the necessary patient information forms have been completed. New appointments will not be confirmed until all paperwork, including intake form, history form, no-show agreement and credit card on file, are collected. You can complete all of these on your own and request a convenient time that works for you by scheduling an appointment online. All open availability will be listed and visible there.
Returning Patients
Please bring all medications to every appointment- even if you have already been seen in the clinic before. This will prevent overprescribing in the case you were seen at an outside clinic or urgent care in between appointments. It will also ensure that all prescriptions are refilled in a timely manner. Prepare a list of questions or concerns that you or your family may have prior to your appointment so that you are ready to discuss everything with your doctor at the time of your visit.
For patients with diabetes or high blood pressure- please bring a log of all your daily blood pressure and blood sugar readings to ensure accurate adjustment of medications with minimal side effects after leaving the office.
Billing
Please plan to take care of co-payments, co-insurance and any outstanding balances at the time of service. Co-payments or deductibles must be paid at the time of visit. We accept debit cards, Visa and Mastercard. If our physicians are not participating with your insurance plan, you will be responsible for any charges incurred. It is the patient’s responsibility to confirm with insurance if we are an in-network provider. As a courtesy, our office will confirm prior to finalizing your appointment. We will provide you a receipt for your insurance company if you are out of network and decide to pursue care with us.
We require a credit card on file for all patients- appointments will not be confirmed without a credit card on file. The reason for this is insurance plans have deductibles, co-pays and co-insurance, and it takes 60-90 days for insurance to finalize your bill. We will send you the finalized bill once received. Outstanding balances will be charged to the card on file. Always notify our office of any change in name, address, phone or insurance information.
Insurance
We accept Medicare, Oscar EPO, Aetna PPO, Cigna PPO, Blue Cross PPO, Blue Shield PPO, Healthnet PPO, and United PPO. Most POS plans are accepted as well. We do not accept any HMO or Medi-cal plans. Prior to your appointment, please verify with your insurance company that our doctors are participating providers.
If not, you will be responsible for the cash price at the time of visit. We will provide you with a receipt that you can send to your insurance company for reimbursement.
Self-Pay Policy
If you do not have insurance, cash pricing is available. Los Angeles Primary Care has contracted with a local laboratory that provides blood work at discounted prices for cash-paying patients, so you can still complete blood work at a reasonable price whether or not you are currently insured. For further information, please view the pricing section of our website for a quote.
Cancellation Policy
To better serve the needs of all our patients, we ask that you call 48 business hours in advance to cancel or reschedule appointments. There will be a no-show fee of $150 if we are not notified at least 48 business hours prior to your appointment.
Refill Requests
We are happy to help with refill requests during regular office hours, so please text us via Spruce to let us know what you need. Please allow ample time for refills- at least 1-week prior notice. The doctor will prescribe an appropriate supply of medication for you at the time of visit. When all of your medication has run out, a follow-up or telehealth visit is required for additional medication refills.
After-Hours & Emergencies If you are experiencing a medical emergency, dial 911. For non-urgent issues, feel free to leave a message, and we will get back to you within 24 hours.