HomeHealth and Wellness Information and ResourcesPre-Appointment Checklist
Irene Teper, MD

Pre-Appointment Checklist

You want to make the most of your doctor's visit, but you don't want to waste time filling out paperwork. Here's what you can do before coming in to the office to ensure that the doctor gets all the information she needs and that all your concerns are addressed:
  • If this is your first visit, print and fill out the New Patient Questionaire and the Appointment Policy forms.
  • Print, fill out, and bring with you the Appointment Checklist.
  • If you were seeing a different doctor in the past, please print and fill out the Release of Information form. Take this form to your former healthcare provider, so that your records can be released to us prior to your visit.
  • Print and fill out the Medical Concerns worksheet (form will be available here soon).
  • If you are planning to travel overseas, let the office know ahead of time in order to arrange for vaccinations.
  • If you are interested in contacting Dr. Teper via email, please understand that email is inherently unsecure and cannot be guaranteed to be timely. Still, some patients have found it convenient and if you would like to have that option, please print and fill out the Email Communication Request and Authorization form.

NOTE: Not all forms are currently available on this website. You can contact the office directly and request that the missing form be either faxed or emailed to you.

165 Rowland Way, Suite 201, Novato, CA 94945
Tel: (415) 897-3174
Irene Teper, M.D.