Patient Forms

Online Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. Please complete the form 48 hours prior to your appointment.  After you have completed the form, please make sure to press the SUBMIT button at the bottom to automatically send us your information.  Forms are active for 90 minutes and will require a restart if not completed during the allotted time.

The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

You must bring your insurance card with you or your appointment will be rescheduled.

ONLINE PATIENT REGISTRATION

 

Printable Forms 

You may save time at our office by printing and filling out our Patient Registration Forms. After you have completed the forms, bring them to your next visit to our office.

If you would like us to print and fill in the forms, please arrive 10 minutes prior so the staff may input your health history.

You must bring your completed forms and your insurance card with you or your appointment will be rescheduled.

Our patient information forms are in PDF file type format. If you need the free pdf reader, click here.

New Patient Packet

Obstetrical History

Release of Records to Dr. Leach

Release of Records from Dr. Leach

EDD Disability Claim

 

 

Pregnancy Handbook

Keep up to date on important issues in women's health care!
Read Dr. Gipp's Column, "PREGNANCY MATTERS"


- OUR AFFILIATION WITH JOHN MUIR MEDICAL CENTER -
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    Learn More About Dr. Leach

     

     

    Watch to the End to See Dr. Leach

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    Learn about John Muir Medical Center's

    Family Birth Center.


What is Mona Lisa Touch?

Location
Timothy A. Leach, MD, Inc.
110 Tampico, Suite 210
Walnut Creek, CA 94598
Phone: 925-231-3625
Fax: 925-935-1396
Office Hours

Get in touch

925-231-3625