East Bay Neurosurgery & Spine
East Bay Neurosurgery & Spine
Gordon Tang, MD
East Bay Neurosurgery & Spine
2510 Webster Street, 3rd Floor
Berkeley, CA 94705
Office : (510) 841-8700
Fax : (510) 295-2651
East Bay Neurosurgery & Spine
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East Bay Neurosurgery & Spine
East Bay Neurosurgery & Spine
Forms
 
For your initial consultation:
Please print and complete the following three forms and bring them with you for your first visit with Dr. Tang:
Patient Registration Form Patient Registration
Financial Agreement/Assignment of Benefits Form Financial Agreement/Assignment of Benefits
Medical History Form Medical History


Medical Records:
If you would like us to provide your medical records for another physician or facility, please print, complete and mail/fax to the our office the following form:
Consent to Disclose Medical Information Form Consent to Disclose Medical Information


Disability Form:
For your convenience, California’s Claim for Disability Insurance Benefits Form is provided below. Fill out pages 1, 2 and 4 only, and Dr. Tang will complete page 3.

EDD requires original forms. Please mail or drop off all four pages to the office, along with a stamped envelope with the following address:

   EDD
   PO Box 1857
   Oakland, CA 94604

EDD Disability Form EDD Disability Form
 
 
 
East Bay Neurosurgery & Spine
 
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