New Patient Information

Patient Information

Patient Agreements

Payments for any and all Medi-Cal service and/or products are due at the time of your visit. 

Medi-Cal Weight Loss Program at The Vein Center & CosMed does not file any claim to any insurance company. Products are non-refundable under any circumstances.

I have received or I have been provided the opportunity to receive a copy of the “Notice of Privacy Practices” that explains when, where, and why my confidential information may be used or shared.

I have been educated about and understand the Medi-Cal Weight Loss Program and give permission to be treated by the Medi-Cal staff at The Vein Center & CosMed.

Health History

Weight Loss History