New Patient Forms

To save your time waiting at our office in Upland, California, we have made all the required forms available for download. These should be printed out, and filled in completely prior to your visit. Please bring these forms with you to Dr. Jan D. Tepper, D.P.M., Inc. on your visit.

• New Patient Information Form
• Authorization For Release of Information
• Notice of Privacy Practices
• Acknowledgement of Receipt of Notice of Privacy Practices
• Medicare Signature On File
• Patient’s Insurance Authorization
• Medical History
• Financial Policy

Patient Education

Read More About Foot and Ankle Conditions and Patient Education