FORMS

 
Dear Patient,
 
Over the years I have strived to create a friendly, trusting, and caring atmosphere for my clients.  This approach is important to me.  As you know, the healthcare industry in our country is undergoing many changes.  It has become standard procedure for insurance companies in California to require medical practices to administer Informed Consent Forms and Arbitration Agreements to patients.  The Informed Consent form tells you about your patient rights.
 
The Arbitration form is a legal agreement which is related to medical malpractice.  In the simplest terms, it states that should such a dispute occur, you are giving up your right to have that dispute decided in court, and you will agree to an arbitration instead.
 
You will be required to sign both of these forms when you come in for your first visit for compliance with my insurance carrier.
 
In addition, I ask you to fill out the Intake Form.  This will allow me to have an in-depth understanding of your health status so that I can give you a more complete and accurate treatment.

Most respectfully yours,
 
Rhonda Epstein L.Ac.

Click on each of these buttons to download the required forms

Intake Form 
Informed Consent Form
Arbitration Form
HOURS OF OPERATION
Tuesdays 9:00am-1:00pm
Thursdays 9:00am-1:00pm
Other hours available upon request
CALL US NOW!
(858) 354-1956
or
Contact Us Online
LOCATIONS
Tree of Life Healthy Birthing & Parenting 
617 Saxony Place, Encinitas, CA 92024
 
G3 Physical Therapy
and Wellness Center
227 N. El Camino Real, #100
Encinitas, CA 92024
 
Appointments in Carmel Valley available upon request.