
FORMS.
a little bit of time now, will save you a lot later
Please download, print, and complete ALL forms provided in the link.
If you have any questions on the Patient Intake Form, please call the office at 805-612-5293.
For billing and insurance questions, email Victoria House at vhouse@housebilling.com
Please remember to bring your completed forms, along with the following pieces of information, to your scheduled appointment:
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Insurance card
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Photo ID
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Referrals (If required by your insurance)
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Co-payments (If required by your insurance)
Please use the link provided to download and print the patient forms.
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If you are using insurance, please click on the button below and complete the Insurance Form:
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If you are paying privately, please click on the button below and complete the Private Pay Form:
Send the Patient Information & Financial Agreement Form
to the billing office at: VHOUSE@HOUSEBILLING.COM
- OR-
Fax to (866) 849-0672.
*YOUR INFORMATION WILL BE VERIFIED AND CONFIRMED VIA EMAIL*
Financial Policy
We require prior verification of eligibility in order to use insurance as the method of payment. If insurance has not been verified, the appointment will be charged out-of-pocket and the fee will be collected at check-in.
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