1844 San Miguel Dr., Suite 316,  Walnut Creek, California 94596,  (925) 938-5252 Office, (925) 938-1343 Fax
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Dear New and Current Patients,
Please fill out these forms and information and bring it with you on the date of your appointment as required.
You should also bring copies of any past testing, treatment records, and inpatient records/discharge summaries, if applicable;

  Adobe Acrobat PDF Reader  

New Patient Forms (Note: all files are in PDF format)

Format

  

 Are you seeing us for Headaches? Yes, Download Package 1, No, Download Package 2
 1) New Headache Patient Information "Package" (includes forms below)
 2) New Non-Headache Patient Information "Package" (includes forms below)

  Individual Forms below

    
 New Patient Information Form
 Non-Headache Patient Letter
 Headache Patient Letter
 Past History, Social, Family History, Form
 Headache Diary
 Headache Questionnaire

  Other Patient/Office Related Forms

    
 Directions/Map of 1844 San Miguel Drive, Walnut Creek, CA
 Midas Questionnaire
 Office Financial Policy 
 HIPAA/Privacy Practice Policy Acknowledgement of Receipt
 Physician-Patient Arbitration Agreement
 CURRICULUM VITAE for TIMOTHY WEI, M.D.
 Other Downloads  
Download MIDAS Questionnaire (PC Version)
You can use this questionnaire on your computer without having to connect to the internet.		  
To download:  Click on download link below, select the save as option, and specify where you want to save the questionnaire.

To Run:  Using the Start Menu, Run option, select the downloaded file and press okay

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Last modified: 01/05/10