Listed below are commonly used forms for our office. Please mail these forms one week prior to your appointment to:
Roy Medical Associates, Inc.
5601 Norris Canyon Road, Suite 340
San Ramon, CA 94583
Or send them via FAX at least 24 hours prior to your appointment to:
(925) 866-8082
You may also bring them with you at the time of your appointment.
Patient Registration Form:
All new patients to San Ramon must complete this form. Also, any San Ramon patients with changes or patients that have not been seen since since February 1, 2008, should also complete the form. If you are a former patient of Dr. Kleinman, please complete the form prior to your first visit with Dr. Roy. Please note that two signatures are required on the second page.
Office and Financial Policies:
These are our current Office and Financial Policies, effective February 1, 2008. Please review them; all patients sign on the registration form that they have read, acknowledge, and agree to these policies. Commonly referred to as the HIPAA notice, as required by the Health Inusrance Portability and Accountability Act.
Effective August 1, 2009, we have a new policy regarding Medical Records. Please click here to read our new policy.
Records Release:
If we require records from your former physician, you will be asked to complete a Records Release form at your next visit. If you would like copies of your records due to a physician transfer or for your personal records, please refer to the Medical Records page on this website for the current fees and policies associated with records requests. 