Forms

If you're a new patient, please complete the following forms and bring them to your first appointment.

New Patient Information Form

If you would like our team to coordinate care with another physician practice please complete the form below to authorize release of your medical record, or the authorization for another physician practice to disclose information to us:


Release of Medical Record Information Form Authorization to Disclose Information Form HIPAA Authorization Form


Location

Vijay Thukral, M.D.

995 Montague Expy Suite 213

Milpitas, CA 95035

Phone : (408) 258-7400

Fax : (408) 258-2175

Email: [email protected]

Office Hours

MONDAY: 9:00 am - 5:00 pm

TUESDAY: 9:00 am - 5:00 pm

WEDNESDAY: 9:00 am - 5:00 pm

THURSDAY: 9:00 am - 5:00 pm

FRIDAY: 9:00 am - 5:00 pm

SATURDAY: Closed

SUNDAY: Closed

Get in Touch

Email: [email protected]

Call: (408) 258-7400