LeanMD Weight-Loss
To our patients
About us
New Patient Forms
Medical Release Forms
Procedure Preparations
What is a GI specialist?
About Dr. Ali Khademi
Office Hours
GI Patient Information
Office Policies
Zeba Anti-Aging Medicine

Welcome to our practice. If you are a new patient, kindly complete all forms. If you have not been to our office within 6 months please fill out first form only. 

1. Patient Information Record: New or Established

2. Confidential Health History

3. Authorization for Disclosure of Health Information

4. Acknowledgment of Privacy Practices

5. Notice of Privacy Practices

On your appointment date, please bring the following:

Completed form/s

Your insurance card/s

Valid identification card

Any co-payment due

Medication list if it applies