Patient Registration

Patient Registration 2017-06-28T16:32:35+00:00

Registration Information

In an effort to minimize time needed to complete your office registration we have supplied our Patient Registration Package and Health Questionnaire below. They are in PDF Format and can be printed or downloaded using your computer.

Patient Registration Package

Health Questionaire

Adobe Acrobat Reader is required to open these files. To download a free copy click the Adobe Reader button.

If you wish to have this package mailed to your home, please call 714-517-2000 or submit a quick contact request. Fill in the required information on each form as completely as possible.

You may mail your completed forms to our office at:

Gateway Medical Center
New Patient Registration
710 N Euclid St
Anaheim, CA 92801

Or, you may bring your completed forms with you to the office on the day of your scheduled appointment.

If this is an emergency, call 911 emmediately.