Forms
Please read, complete, and print these forms to bring with you:
- Consent for Treatment
Note: If there is a divorce decree indicating who has rights to make medical decisions, please provide to us that information. If the financially responsible party is specified, please provide that document to us also. Please see the California Minor Consent Laws document on our site. - Patient Information and History
- Vaccination records if available
- Emergency Contact information
- HIPAA Notice of Privacy
- Release of Medical Records and Exchange of Information,when needed
Note: If there are family members, friends, or other healthcare providers with whom you would like Drs. Sutton and Baer to have permission to discuss your medical information, please fill out the appropriate form.
What to bring with you
- If you have relevant lab or imaging reports from other doctors, please bring those to discuss with the doctor.
- All forms must be received by us prior to the time of the appointment, or the appointment will be re-scheduled. A 50% cancellation fee will be charged for last-minute re-scheduling due to completed forms not being provided to us prior to appointment time.
- Please bring all medications, supplements, and remedies with you.
- Please make a list of questions and concerns you have.
- If you are a patient with cancer, pathology reports and special immunohistochemistry testing results are valuable for the appointment.
Should you need to cancel your appointment, please contact us immediately. Cancellations must be made three full business days in advance of your appointment to avoid a cancellation fee. The cancellation fee is 50% of the appointment fee expected. We will call you to remind you of new patient visits or lengthy appointments.
Communication with our office
Confidentiality and Releases
We will contact you with lab results, etc., and will only give this information to you directly, unless you sign a release form indicating to whom you give us permission to speak. We must have a signed consent form to speak to your spouse.
Phone Vs. E-mail
We are not an electronic medical practice, and rely on ground line telephone (916-671-1780) for routine and urgent confidential communication. Our outgoing e-mail originationg from info@raphaelmedicine.com is encrypted. If you have a sensitive question or piece of information to convey, your unencrypted email to us is not fully protected. Please set up a phone time or send paper information by USPS.
Thank you for choosing Raphael Medicine & Therapies PC! We look forward to your visit!
