New patients: please complete these forms and bring them with you, along with a current insurance card, to your first appointment.  
There is also a Records Release 
form if you are transferring care please send this completed form to your previous provider.  They can fax your records to our office at 559-325-3527. 

Existing patients: for your annual exam, please complete this form, which notes any changes in your health history.

Please use this records release form to request your medical records from us or another doctor. Make sure it is clear from whom you want the records and to whom they are to send it. Allow two weeks for your medical records to be sent.

$15.00 charge for 
a copy
of records
Free from doctor to doctor
$25.00 charge for attorney

We accept phone payments (Visa/Mastercard only)

Existing patients: if you have a change of name, address, phone number or any other information, please print and fill out to bring to your next appointment.  If only your insurance has changed,  bring in the new insurance card.

7050 N. Recreation Ave, Fresno, CA 93720 | Peters and Kroeker, Obstetrics and Gynecology | (559) 325-3515

 

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