If you prefer an in-person clinic please make sure you complete the Covid-19 questionnaire below and request an appointment.

 COVID-19 Questionnaire   

• Have you or anyone in your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit?
• Have you or anyone in your household been tested positive for COVID-19?
• Have you or anyone in your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the past 30 days?
• Have you or anyone in your household traveled in the U.S. in the past 21 days?
• Have you or anyone in your household traveled on a cruise ship in the last 21 days?
• Have you or anyone in your household cared for an individual who is in quarantine or is a presumptive positive or has tested positive for COVID-19?
• Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?
• To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19?

See below for clinic forms to complete before your visit.

NOTE: Please do not request an appointment if you have an urgent medical problem, contact our office at (951) 850-6565.  If you answer “yes” to any of the Covid-19 questions above please schedule a video visit instead.

Patient Registration Forms

Ultra Healthcare Nursing Solutions welcomes you to our practice. Once you have made your initial appointment, you may preregister online by completing the interactive form(s) below, or you may download and print the form(s), fill them out, and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the new patient registration process.

Also, be sure to bring any diagnostic films or other test results that may have been ordered or performed by another physician.

Downloadable Forms:

• New Patient Registration – Consent to Treat
• Health History
• Informed Consent – Telehealth
• Physician Referral

Please note:  It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.