Clinic New Patient Forms & Rates
Planning for Your First Appointment
If you are a new patient to the Yo San University Community Clinic, please arrive 15 minutes prior to your appointment time to fill out the New Patient Forms.
- New patients with appointments with a Master’s Intern, Specialty Clinic (Healthy Aging & Internal Medicine and Orthopedics & Pain) or a Private Practitioner, please fill out and bring the following forms to your appointment:
*For the treatment of minors, the parent or guardian must be present in the treatment room with the minor and practitioner at all times during the appointment.
- New patients to the Women’s Health and Reproductive Medicine Specialty Clinic, please fill out and bring the following forms to your appointment:
Female Fertility Forms
Male Fertility Forms
For all patients, please read YSU’s Notice of Privacy Practices which describes your rights, choices and uses/disclosures of your health information.
Please view our current Clinic Fee Schedule for community patients, YSU students, YSU faculty, YSU alumni and YSU family members. Yo San University Community Clinic rates are subject to change.
If you have any questions about the new patient forms or rates, please contact a clinic receptionist at (310) 577-3006, M-F 8:00 am – 9:00 pm, Sa-Su 8:30 am – 5:30 pm.