To make your patient intake faster and easier, please download and fill in these patient forms, as well as take a photo of the front and back of your insurance card, and email the forms and card photos to us prior to your appointment. Please use the button below to email your forms and card photos, or send them to michele.villegas@bassmedicalgroup.com. You may also download, print, and fill out the patient forms by hand and bring them with you to your appointment. If you don’t already have it, you may need to download Adobe PDF Reader DC to open, print, or fill out the forms.
You may use the button below to email your forms and insurance card photos. Please do not take photos of your patient forms to submit - either fill in the PDF on your computer and email it to us, or bring the printed form with you to your appointment.
