Patient Forms

In attempts to help reduce processing times for patients, we encourage all patients to download the applicable forms below. Please complete each form and bring these with you on the day of your visit. Please note that the fields on these forms can be typed into, and that you can save a copy of these forms on your computer for your records. At minimum, all patients should fill out the following (4) forms: "Patient Registration Form;" "Medical History Form;" "General Disclaimer Form," and the "Release of Information Authorization Form." Complete the "Medicare Disclosure Form" (in addition to the other forms) if you are a Medicare-insured patient.

In addition, please bring with you all insurance information, insurance cards, and any information pertaining to any referring physician(s) or other professional(s) involved in your present medical condition(s), if applicable. Also, please bring some type of photo identification card with you the day of your appointment, and please be prepared to show this to our staff. We take Patient Privacy very seriously, therefore, we require everyone to be properly identified.

HIPAA Policies and Procedures - Notice of Privacy Practices (Please read and print a copy for your records)

Patient Resources

Urgent Care Logo Learn about self-pay and cash patients for uninsured Ross Nathan, M.D., (562) 424-9000, 3918 Long Beach Boulevard, Long Beach, CA, 90807