Forms & Records

FORMS

Most forms are available on the Titan Health Portal.

Privacy PracticesPDF File Opens in new window

Consent to TreatPDF File Opens in new window

Minor Consent FormPDF File Opens in new window
If you are the parent of a minor under 18 years of age, please fill this form out and fax it back to us at 657-278-3069.

Immunization Waiver FormPDF File Opens in new window

No Show/Late Appeal FormPDF File Opens in new window

 

MEDICAL RECORDS

The mission of Medical Records is to maintain complete and accurate medical records, to safeguard all information against loss and use by unauthorized persons, to maintain medical records in a manner permitting prompt retrieval, and to assist Health Services staff and patients as necessary.

To request medical records for yourself or another provider/health facility either:

OR

 

* Pricing for records may vary.