English
Español
Home
e-Care Visits
Telehealth
Appointment Request
Contact
Services
Common Questions
New Patient Forms
Staff
Healthcare Providers
Locations and Hours
Mission
Office Policies
Insurance & Policies
Affiliations
Helpful Links
Links & Resources
Hot Topics!
Immunizations & Vaccines
Prescriptions
Disclaimer
Heathcare Providers:
Michael A. Benavidez, D.O.
Daicy Navarro, MS PA-C
Nanette Rueda-Lopez, PA-C
Adult Ages 18 and up
Authorization
H&P Questionnaire
Insurance Waiver
Patient Registration
Patient Acknowledgement
Pediatric forms ages 0–17
Authorization
H&P Questionnaire
Insurance Waiver
Patient Registration
Patient Acknowledgement
Pediatric Consent
Pediatric Questionnaire
Adultos Edad 18 o mas
Autorizacion
Historial Medico
Renuncia a la Elegibilidad de Seguro
Registro del Paciente
Confirmacion del Paciente
Formas Pediatricas Edad 0–17
Autorizacion
Historial Medico
Registro a la Elegibilidad de Seguro
Registro del Paciente
Confirmacion del Paciente
Consentimiento Pediatrica
Historia Pediatrica
Schedule Appointment
Contact us today to schedule
an appointment
Helpful Forms
Click here to view and print
forms for your appointment
Disclaimer
3a6fa35a270b22435d902b04aa1e1fcf