We look forward to meeting you for your first visit to our Family Practice.




Please complete the following and mail or fax it back to our office prior to your first appointment:

1) The first visit form that applies to you:

Adult first visit (over 18)
Teen first visit (ages 12-18)
Child first visit (ages 6 months to 11 years)
Newborn (0 to 6 months)

2) The signed authorization and acknowledgement page

If you have medical records that you would like to share with us, then please request them by writing to the health providers previously involved in your care. If you have a complicated health history or have undergone extensive medical testing, it is helpful for us to have these records and reports prior to your first visit.

The office is located at 1286 Sanchez Street, Suite A (bottom floor), between Clipper and 26th St. The J-Church MUNI stops about a block away, at Church and Clipper. Street parking is available on Sanchez Street and nearby side streets. Map

We have chosen to focus our energies on improving your health and wellbeing rather than on chasing down insurance reimbursements. Therefore we do not contract with any insurance providers and payment is required at the time of service. We accept personal checks, Visa, Mastercard, or cash. As a courtesy, our office will provide you with a claim form for your insurance carrier. For those patients covered by Medicare, we are non-participating providers, but we will submit a claim form to Medicare on your behalf.

We pride ourselves on the quality healthcare we provide and our commitment to you as a patient. We look forward to working with you in the years to come.

Sincerely,

Daphne Miller, MD
Avril Swan, MD