Form 1 of 4
Patient Registration
Demographics, contact information, contact preferences, insurance, the person responsible for payment, and emergency contact. Required for every new patient. 2 pages.
LAC Medical · Bakersfield, CA
Patient Resources
Everything patients ask our front desk for most, in one place: the new patient forms, the patient portal, what to bring to a first visit, the insurance we accept, and our practice policies. Our office is at 5300 Lennox Avenue, Suite 105 in Bakersfield, and the phone is (661) 735-1710. If you would rather do any of this in person or over the phone, call us — that is a normal way to do it, and there is no charge for the help.
New patient forms
Download, complete, and bring these to your first visit. You can fill them in on your computer (Word document) or print and complete by hand (PDF). If you can't print them, no problem — bring whatever you have and the front desk will help you finish at check-in.
Each form is available in English or Spanish. Please complete every field that applies — if a field doesn't apply, write N/A.
Most new patients should take the complete packet: it is all four forms in one file, so nothing gets forgotten. The individual forms are below it if you only need one. All forms are on the current v2026.05 revision.
Recommended · Complete packet
Complete New Patient Packet
Patient Registration + Medical History + Financial Policy + Release of Information, combined into a single 9-page packet. One download, nothing forgotten. PDF only.
What is inside the 9-page packet, in order:
- Pages 1–2 · Patient Registration
- Pages 3–6 · Medical History
- Pages 7–8 · Financial Policy
- Page 9 · Release of Information
The complete packet exists in PDF only. The four individual forms below are offered as PDF and as Word documents, in both languages.
Prefer the forms separately? Download them individually.
Form 2 of 4
Medical History
Reason for your visit, current medications, allergies, past surgeries, current conditions, family history, and lifestyle. Fill in what you remember; we go over the rest together at the visit. Required for every new patient. 4 pages.
Form 3 of 4
Financial Policy
Patient responsibility for copays, no-show policy, billing terms, and consent to bill insurance. Read it, initial each section, sign the last page, and bring it to your first visit. 2 pages.
Form 4 of 4
Release of Information
Authorizes LAC Medical to request your medical records from a prior provider so we can pick up your care without gaps. Only needed if you're transferring from another doctor. 1 page.
The forms are not submitted through this website. Bring the completed paper to your visit, or come in early and finish them with the front desk.
Patient portal
Our patient portal runs on healow, the portal that works with our medical record. It is open 24 hours a day, so you can handle the routine things whenever it suits you instead of waiting on hold.
There is no charge for the portal. It works from a phone or a computer — there is nothing to install if you would rather use a web browser.
Go to the patient portal
Log in to request an appointment, view your records and lab results, pay your bill, or send a message to the office.
Open the patient portal →Direct link: https://health.healow.com/LACMEDICALINC (opens in a new tab)
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Request an appointment
Send a request for a new or follow-up visit and the front desk calls you back to schedule.
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Pre-register before your visit
Fill in or update your information ahead of time so check-in is shorter.
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View records and lab results
See your visit records, lab and imaging results, and your current medication list.
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Pay your bill
Pay a statement online instead of calling or mailing a check.
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Message the office
Send a non-urgent question to our staff. Call the office for anything urgent; call 911 in an emergency.
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Don't have access yet?
Ask the front desk to set it up — at check-in, at checkout, or over the phone at (661) 735-1710. We send the invitation to your email and walk you through the first log-in. If you already have an account and can't get in, call us and we will reset it.
There is no charge for portal access.
Portal messages are for non-urgent questions, and we answer them during office hours. If something is urgent, call the office at (661) 735-1710.
If it is an emergency, call 911.
Before your visit
Plan to arrive about 15 minutes early for a first visit. That is enough time to check in, finish any paperwork, and get your insurance on file without pushing your appointment back.
Bring these four things:
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Photo ID
A driver's license, state ID, passport, or consular ID.
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Your insurance card
Bring the card itself, plus any secondary or Medicare Advantage card. If your plan changed recently, bring the new card.
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Your current medication list
Names and doses of everything you take, including over-the-counter medicine, vitamins, and supplements. Bringing the actual bottles works just as well.
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Your completed new-patient forms
The packet or individual forms from the section above, filled in and signed. Bring them on paper — the forms are not submitted through the website.
If you are transferring from another doctor, bring the name and phone number of that office and sign the Release of Information form so we can request your records. If you have recent lab or imaging results in hand, bring those too — they help us pick up where your last doctor left off.
If your plan has a copay, it is collected at check-in.
If your paperwork isn't finished, come anyway. The front desk will finish it with you at check-in, in English or Spanish. Nobody gets turned away over an unfinished form.
If you need to cancel or reschedule, call (661) 735-1710 as early as you can so we can give the slot to another patient. Cancellation terms are spelled out in the Financial Policy form above.
Insurance we accept
These are the plans we take at our Bakersfield office. If you don't see your plan, call — most major commercial plans are accepted, and the front desk can check your specific plan before you come in.
- Medicare Part B
- Qualcare HMO
- DHMN HMO
- Major commercial plans
Two plans we cannot accept: Medi-Cal and Kern Family Health Care. We are sorry to turn anyone away, and we would rather you know now than find out at the front desk. If you carry one of those plans, call us at (661) 735-1710 and we will point you toward offices in Bakersfield that do take it.
Bring your insurance card to every visit so we can keep your coverage current, and tell us right away if your plan changes. If your plan has a copay, it is collected at check-in. How billing works, and what you are responsible for, is spelled out in the Financial Policy form above.
If you are not sure what your plan covers, call the front desk before your appointment. There is no charge for the question.
Help with the forms
Need help with the forms? Call the front desk at (661) 735-1710. There is no charge for any of this.
We have Spanish-speaking staff every day the office is open. We can read the forms to you over the phone, explain any field, or have printed forms ready for you in person at your first visit. If you would rather not download anything at all, that is fine — come in and we will hand you the paperwork and help you through it.
If you use a screen reader, need large print, or need another accommodation to complete the forms, tell us when you call and we will arrange it. Our accessibility statement explains what the site and the office provide and how to reach us if something isn't working for you.
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Call the front desk
Ask for help with any form.
(661) 735-1710 →Spanish-speaking staff available every day the office is open.
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Help in person
Come to the office at 5300 Lennox Avenue, Suite 105, Bakersfield, CA 93309, and we will have printed forms ready and help you complete them.
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Accessibility accommodations
Large print, having forms read aloud, and other accommodations are available on request.
Read our accessibility statement → -
Prefer Spanish?
This whole page is available in Spanish, with the same forms and the same portal link.
Ver esta página en español →
One note on privacy: please do not send medical information by email, and do not email us a completed form. Email is not a secure channel. Bring the paperwork with you, hand it to the front desk, or use the patient portal, which is secure.
Practice policies
These three documents cover how we handle your health information, your privacy on this website, and accessibility. You can read them here any time.
At your first visit you will also sign an acknowledgment that you received our HIPAA Notice of Privacy Practices. You can read it ahead of time at the link below so nothing at check-in is a surprise.
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HIPAA Notice of Privacy Practices
How LAC Medical uses and protects your health information, and what rights you have over your records.
Read the HIPAA notice → -
Accessibility statement
What we do to keep this site and our Bakersfield office usable for everyone, and how to tell us about a barrier.
Read the accessibility statement → -
Privacy Policy
What this website does and does not collect. We do not run advertising pixels or analytics trackers on this site.
Read the Privacy Policy →
Request an appointment
Send a request and our front desk calls you back to schedule. We answer requests within one business day. New patients and current patients both use this form.
The form asks for three things: your name, your phone number, and the best time to call you. Our office is at 5300 Lennox Avenue, Suite 105 in Bakersfield.
- Please do not include medical information in the form. Save it for the visit or the phone call.
- If this is a medical emergency, call 911.
If the form does not load, open it in a new tab.
Prefer to call? (661) 735-1710
Already a patient? You can also request an appointment, view results, and pay your bill in the patient portal.