Save time by completing forms prior to your first appointment.
Phone Numbers
For Appointments: 951 684 1944; 951 684 2627
Dr. Kotomori's appointments are scheduled by office staff
All other clinicians schedule their own appointments
Bring To The Appointment
Insurance Card, Co-Payment ,Referral Forms, Legal Identification, Completed intake form
First Time Visit? Please complete the following forms and bring them with you to your first appointment. Note Caregiver Affidavit is to be completed if you are not the parent or legal gaurdian of the child you bring to treatment. The HIPPA form describes your right to privacy regarding your medical records. Please print, sign and bring to your first appointment.
The forms may not be e-mailed as your signature is required. None of the information entered on the forms is saved. Enter information with key board then print form. Complete the prinited form with pen.
