DR. SAMUEL BOLIVAR

New Patient Information


Welcome to my practice

To make your first visit as complete as possible I would like you to bring the following items:

All Medications

All Herbal supplements

Any records you may have

Your ID card

Your Insurance Card

The name, address and telephone number of your previous doctor so that we may request your medical records

A list of your medical history

A list of your problems and/or concerns that you may want to discuss with the doctor.

Print out the new patient information forms to complete and bring
with you on the day of your first visit.

We look forward to seeing you!!! 

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