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Forms

All forms require the free Adobe Acrobat reader:



New Patient Registration
Authorization to discose health information
Contract Between Adult Med House-Call Physicians And Patient
Initial Health History
Privacy Practices

Instructions:
  • Complete forms and send deposit of $750.00 (see fee schedules) to the address below.

  • Please make a copy of forms requiring signatures for your records. If unable to do so, please inform me and I will bring a copy to your first visit.

  • Mail or fax the completed forms to:
  • Laurie F. Draughon, M.D.
    231 Market Place #115
    San Ramon, CA 94583
    Phone: 925 324-8227
    Fax: 925 648-1746
    E-mail: DrLaurie@LD-MD.com

    231 Market Place, #115, San Ramon, CA 94583
    Fax: 925 648-1746 - Phone: 925 324-8227 - E-mail: