Please read the information below before calling the office to become a new patient. We are not providers for Medicaid.
Dr. Quintana is no longer accepting new patients.
Please complete the items listed below and fax, mail or drop off at the office. Once we receive your completed paperwork, you will be contacted to schedule your first appointment. We can usually schedule a new patient appointment with one of the providers within 10 days.
Patient Forms
- Patient Demographics and Consent
- FFM Financial Policy 2020
- Credit Card on File Agreement
- Medical history form
- Medical Records Request TO FFM– especially If you have a complicated medical history
- Copy of insurance card (both sides, please)
Additional Information and Forms
- Notice of privacy practices
- Minor Consent Form
- Office Financial Policy
- Medical Records Request FROM FFM
- Pay your bill online for patients enrolled in our patient portal
Select the form that you find of interest and it will download to your computer or open up within Adobe Acrobat Reader® within your web browser.
If you do not have the Adobe Acrobat Reader® click here to have it installed onto your computer.