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Forms: Can be emailed to frontoffice@sandimasfamilypractice.com

You will find several forms available here for you to download, print and then fill out. This will give you time to complete the information requested and will save you time on the day of your appointment.

 

For Established Patients
  Current Visit Information Form  
  Medical History Form  
  Request for Patient's Medical Records  
  Informed Consent for Procedure  
  Consent for Release of Protected Health Information  
  Advance Directive (Must be signed and witnessed by 2 people, need not be notarized)  
     
For New Patients
  Patient Insurance Information  
  Medical History Form  
  Consent to Treat Minors  
  Acknowledgment of Notice of Privacy Policies  
  Notice of Privacy Policies  
  Request for Patient's Medical Records from other doctor  
  Consent for Release of Protected Health Information  
  Advance Directive (Must be signed and witnessed by 2 people, need not be notarized)  

 

 

 

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My Medicine

Dr. Kavitha Kotrappa, a Board Certified Family Medicine Physician, leads a team of experienced and compassionate health care professionals to offer the best health care for your entire family. She has received numerous awards for quality of care and is one of the most respected physicians in the community. She has been practicing in the San Gabriel Valley area since 1996.    

Jason Wagner, PA-C, is a well respected Certified Physician Assistant.

Our Patients

Adults and Entire Families.
Women
Children as young as 6 months old
Seniors
Teenagers
Veterans

Our Treatments

Physicals, Well-women exams, well-child exams, Sports Physicals, Work-Physicals
Vaccinations, Immunizations, Flu Shots
Blood Tests - We have an inhouse lab for your convenience)
Skin Biopsy, Skin cancer exam
Aesthetics: Laser Hair Removal, Botox/Restylane, IPL
Joint injections, Arthritis
Kidney function, Diabetes maintenance
Cardiac Risk and Maintenance
Injuries (sports, work-place)

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