DBA : Optilife, Inc.
Anaheim, CA 92806
ph: 714-520-9759
fax: 714 948 2368
gawdibel
(IF PREFER, THEN THE PDF FORMAT ( PDF LINK) )
The 4 forms must get to the office at least one day before your appointment date. Otherwise we may not be able to have time to process these, and you risk a charge of a late fee of $50 All appointments are by video/virual.
The time it takes you to fill the forms is way less than the time it would take you to drive to the office and back.
The 4 forms can be reached with the following URL links, so you can fill then out on your cell phone or computer. (Click on:) If you are sure all are up to date, then only the followup form is required.
Clinical Followup form1
Update needed for pharmacy contact information, etc
6 additional WAYS TO FILL OUT FOLLOW-UP FORM 1:
1 Register for a "patient portal" to Dr Di Bella,(click the link) Patientfusion. (takes less than one minute) After you have an appointment, the program will send you a link to provide the needed information, on your cell or computer. Patientfusion will send us your answers.
2. If you have a printer,
The top half of the form (in the links below) is filled out for all visits after the first time, for all your concerns and issues. Over time you will appreciate that the accuracy of filling these out carefully will reap benefits. The time it takes is well worth it. (5 minutes on average) There are 3 format versions, to be sure you have one that will work on your computer, by printing or cell phone:
FOLLOWUPFORM, PDF version with dropdowns
Followup form RTF version . This will download then you have to open.
Copyright 2012 Dr. Geoffrey Di Bella. All rights reserved.
DBA : Optilife, Inc.
Anaheim, CA 92806
ph: 714-520-9759
fax: 714 948 2368
gawdibel