Patient Information
Jimenez RX Pad (click to view .pdf)
Jimenez Map (click to view .pdf)
Consent for Treatment & Financial Policy (click to view .pdf)
Consent for Treatment & Financial Policy - Spanish (click to view .pdf)
Notice of Privacy Practices (click to view .pdf)
Notification of Patient Responsibility for Co-Payments Co-percentages and Deductibles (click to view .pdf)
Patient Medical History (click to view .pdf)
Last Updated Wednesday, September 17, 2025 - 08:17 PM.