Patient Forms

Forms and Practice Policies:

forms and practice policiesFor your convenience and to help minimize your wait time, please feel free to download the forms and policies to fill out prior to being seen in our facility.

Patient Information Form
Health History Form
HIPAA Authorization Form
HIPAA Notice of Privacy Practices
Insurance Billing Policy
Gateway Medical Center Admin Policy
Lifetime Medicare Signature Form
Medicare Secondary Payer

Anderson Walk-In
Medical Clinic

2760 Balls Ferry Road
Anderson, CA 96007
Phone: 530-365-4412
Fax: 530-365-5186

 

Email:gatewaymedicalcenterinc@gmail.com