New Patients

Dear Patient:

Thank you for selecting us as a medical provider for your healthcare needs. It is our privilege to provide high quality gastroenterology services and advanced endoscopic procedures to you. We would like to take this opportunity to welcome you to our medical office.

Enclosed please find a registration package with forms to complete. You may also download these forms at Please take the time to fill out these forms completely and accurately and bring them with you on your first appointment or mail them at least 5-7 days prior to your appointment. This helps us to provide more time during your visit to discuss management plans. Please review the Notice of Privacy Practices enclosed in your package and sign acknowledgement section of your health questionnaire.

In order to provide the best quality medical care, we would like to request you to bring any necessary referral letter from your referring physician and any pertinent laboratory or imaging reports (not the disc) performed within the last 3-6 months. You may ask your referring physician to mail or facsimile (Fax) these reports to our office. This will ensure our physician to have necessary information to proceed with your care.

Please bring your insurance card and a pictured ID card with you so that we can make a copy from your card. According to insurance industry regulations, we have to collect co-payments at the time of office visits. Checks and cash are accepted at the time of service. Your cooperation in this matter prevents rescheduling your appointment. If you do not have insurance, total payment is expected at the time of service. We are sorry that we do not accept credit cards.

It is our mission to accommodate all patients. Please cancel your appointment at least 3 days prior to your appointment so that we can accommodate other patients in need of healthcare. Your attention to this matter prevents charges for not showing for your visit. Your insurance company will not cover this charge. Charge for late office cancellation is up to $100. Charge for cancellation of a scheduled procedure if not cancelled 3 days prior to procedure is at least $250. We understand emergency situations are out of your control.

Federal and State law allows us to use and disclose our patients’ protected health information in order to provide health care services to them, to bill and collect payments for those services, and in connection with our health care operations. We also use a shared Electronic Medical Record that allows both our physicians and staff and certain of the participating physicians of Muir Medical Group IPA and their staff access to our patients’ health information. The purpose for this access is to expedite the referral of patients within the Muir Medical Group IPA system and to assist in providing and managing their care in a coordinated way. Information in the Electronic Medical Record can be released outside the Muir Medical Group IPA system only with the patient’s express authorization or as otherwise specifically permitted or required by law.

Your health and concerns are important to us. We do our best to provide high quality healthcare for you. Please provide a list of questions prior to your visit to utilize your visit efficiently.

We appreciate you for choosing us and welcome you to our practice. If you have any questions or need directions, please do not hesitate to call us at (925) 939 5599. We are looking forward to your visit.

Thank you,
S. Saeed Zamani, M.D.