Neal Mazer, MD, MPH New Patient Registration

(current patients only)

Welcome to the practice of Dr. Neal Mazer.

Please complete the following paperwork before your first appointment.

Adult Patient

New Patient Intake Form

Office Practices and Billing

Notice of Privacy Practice

Adolescent Patient

New Patient Intake Form

Comprehensive child history

Consent to Treat A Minor

Office Practices and Billing

Notice of Privacy Practice

Once you have completed your paperwork please fax to my office manager (Amy) at 805.919.5261 so we can prepare your chart.

Or

Bring with you to your first appointment.

Thank you ~

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