Patient Forms

Here you can take advantage of the Internet and receive services from our office without leaving your computer.

New Patients:

We strive to see patients on time and by completing the following forms in advance, as opposed to waiting to do them upon your arrival at our office, we can work together to achieve this common goal.

 


New Patient Forms

Please do the following:

  1. Click on PDF document to the left to download
  2. Complete all forms on your computer
        (Alternatively you can print & complete forms with black ink pen)
  3. Print & sign completed forms
  4. Bring completed forms & insurance card(s) to your appointment
Other Forms:

Medical Record Release Form

Please do the following so we may obtain copies of your previous medical records, review them, and have them ready for your office visit:

  1. Click on PDF document to the left to download
  2. Complete form on your computer
        (Alternatively you can print & complete forms with black ink pen)
  3. Print & sign the form
  4. Fax the form back to our office now (510) 796-7760

California Disability Form

Please do the following so we may help you obtain state disability benefits during your absence from work (If greater than one week):

  1. Click on PDF document to link to online form
  2. Then click on “Register for SDI Online
  3. Complete the online form
  4. Provide the receipt number to us and we will then complete the physician portion online and then it’s filed with the California Employment Development Department.

California Sterilization Form

Please do the following so we may proceed with authorization of your permanent birth control (Sterilization) procedure— California law requires that this form must be completed at least 3 days in advance of your procedure:

  1. Click on PDF document to the left to download
  2. Complete form on your computer
     (Alternatively you can print & complete forms with black ink pen)
  3. Print & sign the form
  4. Fax the form back to our office now (888) 811-0578

Forms Require Free Adobe Reader Software download here if needed

Appointment Requests

Dr Scott Kramer

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DR. SCOTT KRAMER

Voted One of Northern California’s
Best Gynecologists

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Surgeon

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Less pain, less cost,
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