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Call Us Today!
(530) 894-0500
Call Us Today!
(530) 894-0500

Patient Forms

New Patient Packet
Prospective patients can print, complete and submit their completed packet to our office. Please indicate your physician preference, while understanding our practice is currently very full, with many physicians unable to accept any new patients. Please contact our office for further clarification.

Before accessing the forms, please note that our practice is not contracted with all insurance policies and we are unable to accept any further Medi-Cal, CMSP or private/self-pay patients. Please contact your insurance to verify who your local contracted providers are.

Annual History Update
Please print, fill out and bring this packet with you to your annual preventive visit (also referred to as your wellness or WellCare exam, CPE or complete physical exam or simply "physical").

Medical Record Release Form
Please print, fill out completely and submit this form to us if you have established that you would like us to fax a request for another physician to send us your previous records. Feel free to communicate with your physician regarding which records would be helpful. We will scan and shred the desired records upon receipt unless otherwise discussed.

HIPAA Release Form
Please print and fill out this form to allow us to discuss your medical care with individuals of your choice.


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Call Us Today At ♦ (530) 894-0500

Contact Information
Mission Ranch Primary Care
114 Mission Ranch Blvd., Suite 10
Chico, CA 95926

Phone: (530) 894-0500
Fax: (530) 345-2532
In Business Since 1988
Business Hours
Mon.-Fri: 7 a.m. - 5 p.m.
Sat: Closed
Sun: 9 a.m. - 1 p.m.
Payment Options
Patient Portal: Click here to sign in
Insurance, Invoicing Available