Sieu Truong, MD & Samina Makani, MD

Friendly, expert OBGYN care
in Encinitas, California

Patient Forms

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.

If you would like to fill out and bring your new patient forms prior to your appointment, please view link below:

NEW PATIENT FORMS – WIH

If you are an existing patient coming in for your annual exam, please fill out and bring your annual forms below:

Annual Form – WIH

If you would like to view our notice of privacy practices, please view the link below:

Notice of Privacy Practice CPA 10.2021

Menu