Patient Registration Form

After you press the Download Form button you'll need to save the form to your device in order to be filled out.

 Once saved on your device, please fill out the form save it again, and email it back to us.  

Please email the registration forms to : appointment@mankongleungmd.com

1. FILL OUT THE FORM in its entirety.

2. ATTACH A COPY OF YOUR INSURANCE CARD, FRONT, and BACK.

3. MAIL or FAX or EMAIL the form back to us. Please see the above letterhead for the address and fax number.

•  You can scan the forms and insurance card into pdf files and email them back to us.

•  You can also use your mobile phone to take a picture of each page of the form and insurance card and email us the pictures of all the pages.

4. AS SOON AS we receive the form back from you, my staff will call you to schedule an appointment. The sooner you get the form back to us, the earlier we can call you to schedule an appointment.

5. CONTACT LIST. Add my office phone number (925) 600-8220 into the contact list on your mobile phone, so that your mobile phone caller ID will show my name when I call you.

6.  BEST PHONE NUMBER. Please provide the very best phone numbers that I can reach you. Preferably mobile phone numbers. Do not worry that you will miss my call. If you are not available, I will call you the next day. I will keep calling you many times until I reach you. Rest assured.