In order to make your visit with us as productive as possible, we request that the following be reviewed, completed, and signed prior to making an appointment. Please be advised that the arbitration must be completed and returned in color and may not be altered. If you do not have access to a color printer or scanner, our receptionist can send this to you prior to your visit or you may sign it in our office the day of your consultation. We also ask for a clear copy of the front and back of your insurance cards and photo ID. 

• Please complete all the below forms and send a copy of your insurance cards and photo ID to office@mozaiccare.com or by fax 415-395-9897.

​

​

** PLEASE BE ADVISED THAT DUE TO LICENSING REGULATIONS AND RECENT LEGISLATIVE CHANGES, WE CAN ONLY OFFER TELEHEALTH SERVICES TO PATIENTS WHO LIVE IN CALIFORNIA. IF YOU LIVE OUTSIDE OF CALIFORNIA, YOU WILL NEED AN IN-PERSON VISIT WOT SEEK SERVICES WITH OUR OFFICE**