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Patient Information

Patient Forms and Instructions
What to Bring to Your Appointment
Appointments and Cancellations
Insurance and Payment Information
Hospital Affiliations
Privacy Practices

Patient Forms and Instructions

For your convenience we have provided the following patient forms and instructions for you to print and complete before your office visit. [Help for accessing and printing forms]

• Receipt of Notice of Privacy Practices Written Acknowledgement Form
• Patient Information Form

What to Bring to Your Appointment

If you are a first-time patient, please plan on arriving early to complete a patient registration form. Please bring the following items to the appointment:

• Insurance card(s)
• Referral forms (if required)
• List of all prescription and over-the-counter medications that you are currently taking
• Any required co-payment
• Pertinent medical and surgical history information
• X-ray films that you may have

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Appointments and Cancellations

We realize that our patients' time is valuable, and we make every effort to see patients at their scheduled appointment time. We ask that patients provide as much advance notice as possible when running late for an appointment or when cancelling. With this advance notice of cancellation, the time can be scheduled for another patient.

Insurance and Payment Information

We are a Medicare provider and accept most major PPO insurance plans. Unfortunately, we currently do not accept Medi-Cal in our office. We encourage all patients to confirm their coverage prior to making an appointment. Co-payments are due at the time of the appointment. You are responsible for any unpaid balance not covered by insurance. We accept cash, check, or credit card for payment.

Please call us with any questions regarding which insurance plans we accept or other billing concerns. Insurance coverage and benefit questions should be directed to your health insurance provider.

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Hospital Affiliations

Our practice is affiliated with the following medical facilities:

• Thousand Oaks Surgical Hospital
• Los Robles Regional Medical Center

Privacy Practices

Notice of Privacy Practices for Hai-En Peng, D.P.M.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

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