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New Patients: Please download both Patient History Form
and Financial Disclaimer Form below and complete at home
and bring with you along with your insurance card for your first visit or
plan to arrive at our office at least 25 minutes before your
scheduled appointment time to fill out your patient history in the office.
Thank you for your understanding.

Records Release (Sending Out)
Records Release (Coming In)

Disability Claim Instructions
Disability Claim Form

RX PREAUTH FORM (DR. ZAID)
RX PREAUTH FORM (DR. TRUONG)
RX PREAUTH FORM (DR. MAKANI)


New Patient - Patient History Form
(please complete and bring to first visit)

New Patient - Financial Disclaimer Form
(please complete and bring to first visit)

Notice of Privacy Practices
Women's Integrative Health | Encinitas Ob/Gyn
Women's Integrative Health | Encinitas Ob/Gyn
Women's Integrative Health | Encinitas OB/GYN
477 North El Camino Real Suite C304
Encinitas, CA 92024
Phone: (760) 635-3777
Fax: (760) 942-7163
Copyright © 2009 Women's Integrative Health
Home | Doctors | Obstetrics | Gynecology | Anti-Aging | Contact Us
WIH OB/GYN Physicians
Angelica M. Zaid, M.D.
Sieu P. Truong, M.D.
Samina S. Makani, M.D.
Patient Forms
Site Design: WIH
Photography:
Bob Bretell
Sieu Truong, M.D.
Angelica Zaid, M.D.
Samina Makani, M.D.