The following forms are used at Ventana Health to help us better understand your health needs and to clearly explain the nature of many of the procedures performed at our office.

They can be viewed with Adobe Acrobat Reader, which is typically available on any computer. If that text reader is not on your computer, it can be downloaded for free here.

New Patient Application Kit
This kit contains all of the information and forms needed to become a new patient at Ventana Health. When completed - please mail, fax, or drop off these documents to our office.

Esthetic Services Price List
This is the comprehensive and up-to-date price list for all of the esthetic services at Ventana Health. Prices are effective February 1, 2007.

California DMV Disabled Placard Application
Use this form if you are applying for a disabled driver placard.

California POA for Healthcare
This document names the individual that can make medical decisions for a patient if the patient is unable to do so due to illness or injury.

Financial Policy

This is the complete financial agreement for Ventana Health. All patients seeking non-emergency care at our office after June 7, 2007 will be required to acknowedge agreement with this policy. Please note that the annual fee for non-covered services is now optional.

HIV Testing Consent Form
This form is required in California for testing of HIV antibodies.

Post-Procedure Wound Care
It is important to properly take care of a skin wound after a skin biopsy or laceration repair. This sheet has everything you need to know to help your wound heal properly.

Skin Biopsy Consent Form
A skin biopsy is the only test that can diagnose skin cancer. This form clearly explains the risks and benefits of this relatively simple procedure.

Cryotherapy Consent Form
This form explains the benefits and risks of cryotherapy.

Health Information Disclosure
If you wish for us to send your protected health information to another office or entity, this completed form will be necessary.

Notice of Privacy Practices
This document clearly explains the privacy practices at Ventana Health.