317 Lennon Ln Ste 100
Walnut Creek, CA 94598

Phone 925-934-5420

Mail@DrFitzgerald.net

New Patient Forms

As a new patient we need to gather information from you as well as provide you with government-mandated notices.

  1. Please click on the "Patient Registration Online Form" below, complete it (except for your signature) then press "Submit". We will print a copy for you to sign at your first visit.
  2. Please read the "Easy Pay FAQ."
  3. Please review the "State and Federal Notices".

Please complete the following prior to your first appointment.

Current Patient Forms

If Cheryl asks you to fill out a heath update, please click below and complete it (except for your signature) and then press "Submit". We will print a copy for you to sign at your next appointment.

You may have a PDF Preview Browser Plug-in either installed or enabled on your system. PDF Preview Browser Plug-ins DO NOT contain all the necessary features that are required to submit forms online. If you would like to submit your forms online please follow the instructions below, these links may help you enable the Official Adobe Acrobat Reader for your browser.

1)Get the latest official release of Adobe Acrobat Reader


2)When asked make sure you enable Adobe Acrobat as your default PDF viewer
3)Make sure that you are running Safari in 32 bit mode
You DO NOT have Adobe Acrobat Reader installed and/or enable, if you would like to accurately view, fill-out, print or fill out our forms online please download Adobe Acrobat Reader

1)Get the latest official release of Adobe Acrobat Reader


If cannot submit the forms on line or if you do not want to download Adobe Acrobat Reader, please feel free to print our forms below, fill them out, and bring them into our office.

Current Patient Forms

If Cheryl asks you to fill out a heath update, please click below and complete it (except for your signature) and then press "Submit". We will print a copy for you to sign at your next appointment.