Hana Saleh, MD
Internal Medicine
Office Location
Map
Patient Resources New patient forms, notices, directives, and more 11 items
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New Patient Forms
Intake forms for new patients. Please complete before your first visit.
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Notice of Privacy Practices
How your medical information may be used and disclosed, and your rights regarding it.
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Authorization to Disclose Health Information
Use this form to authorize release of medical records to another person or entity.
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Controlled Substance Agreement
For patients prescribed controlled medications.
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Physician-Patient Arbitration Agreement
Required under California Code of Civil Procedure § 1295.
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Staying Healthy Adult Assessment
Health assessment questionnaire for adult patients.
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Medications Record
Track your current medications, dosages, and prescribing providers.
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TB Test Form
For established adult patients with no prior TB test or prior negative result.
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IHA Periodic Assessment
Initial Health Assessment periodic evaluation form.
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NextMD Patient Portal Instructions
How to sign up for and use the NextMD patient portal.
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Contrato de Narcóticos (Español)
Para pacientes a quienes se les recetan medicamentos controlados.
At a Glance
Affiliated Organization
Dr. Mathias Primary Care Associates, Inc. — PrimaryOther Providers You Might See
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Paula Henderson, MD
Hemet
Accepting new patients -
Herman Mathias, MD
Hemet
Accepting new patients
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