Here at Coast and Aloe Medicine and Aesthetics, we value our patients. We acknowledge that going to a new place for the first time can be nerve racking. We want to do everything we can to eliminate any unnecessary stressors, which is why we include the option of printing and completing your forms at home. We think of our patients as part of our extended family, and we are excited to meet you! We advise you to arrive at least 15 minutes early for your appointment.

New Patient Forms

Patient Registration Form
Download & Print - Online Form

Patient Health History
Download & Print - Online Form

TB Risk Assessment
Download & Print - Online Form

Signature Page Form
Download & Print - Online Form

If you have any questions regarding your first visit, please don’t hesitate to call us at (424) 888-6298.

Agreement & Notices

Arbitration Agreement
Download & Print - Online Form

Notice of Privacy Practices English
Download & Print - Online Form

Notice of Privacy Practices Spanish
Download & Print - Online Form

No Show Policy
Download & Print - Online Form

Responsibility of Payment Form
Download & Print - Online Form

If you have any questions regarding your first visit, please don’t hesitate to call us at (424) 888-6298.

Other Forms

(To be filled out as needed)

Release of Information
Download & Print - Online Form

Accepted Insurances:

We ACCEPT all PPO and EPO insurance.
Most HMO Health Plans including but not limited to Anthem Blue Cross, Blue Shield, Health Net, LA Care Covered California and many more.
Medicare Part B and Medicare Senior Plans under HMO Health Plans such as Humana, Scan, Wellcare and more.

Please call the office to confirm that we accept your Health Care Insurance prior to your appointment!