Dr. Bastidas request that you take the time to fill out these forms before arrival to the office. We have found that it may be easier and less stressful to fill out these forms when you have reference to documents and/or medications you may forget to bring to the office the day of your appointment. Please bring the completed forms to the office the day of your appointment. If you cannot do so, please show up 15 minutes before your scheduled appointment time. Thank you in advance. If you have any questions please do not hesitate to call the office.
If you are a Medicare patient you are excluded from completing the Out Of Network form as well as The Assignment of Benefit form.
If you use any other insurance/no insurance please complete all forms.