New Patient Paper Work

  • Your Contact Information

  • Medical Insurance Information

  • Social History

  • Family History

  • Review of systems (Are you experiencing any of the following? Please check all that apply)

  • Missed appointments Fees and Rescheduling

    Our physicians want to be available for your needs. Unfortunately when a patient does not show for their scheduled appointment, another patient loses an opportunity to be seen. So if you are not able to make your appointment, please call us before 10 am on the business day prior to your appointment, otherwise a fee of $25.00 will be billed. Schedules fill up quickly, if you miss an appointment without calling, we may not be able to reschedule as soon as you would like. This policy enables us to better utilize available appointments for our patients in need of medical care.

    Copays and other charges due at time of service?

    Copayment is expected at the time of service. Services provided which are not a covered benefit of your health plan will be your financial responsibility.

    How to refill a prescription

    If you need a prescription refilled please plan ahead. Many Rheumatology medications should not be discontinued or stopped unexpectedly. Complete the online medication refill request form on the Southland Arthritis website for the fastest response time. Call your pharmacy to request a refill 5 working days in advance. Do not call our office. If you already have refills authorized, the pharmacist will be able to fill your prescription quickly. If you do not have refills then the pharmacist will notify our office. It will take 3-5 working days to complete the authorization for your prescription and inform the pharmacy. Mail order prescriptions will also need 5 working days to complete.

    Forms/Record Requests

    There is a charge for most forms, such as Jury Duty excuse, DMV placard, disability exam form, FMLA form.

    If you are coming from another Medical Group or Doctor's office you can request your records be sent here. A signed medical release by you will initiate that a copy of your records be sent. The form will need your signature and to be mailed to your previous physician's office. If you are already an existing Southland Arthritis patient and an outside physician is requesting your records, a signed release is also needed. On the average most facilities require about 15 working days to have the records copied and sent.

  • Authorization For Release of Medical Records

  • Electronically to our HIPAA complaint email address: records@southlandarthritis.com

    Fax: (855) 306-0135

    Offices Addresses:

    • Hemet Office: 949 Calhoun Pl, Suite F, Hemet, CA 92543
      Phone (951)652-5000; Fax (855) 306-0135
    • Menifee Office: 29798 Haun Rd, Suite 301, Menifee, CA 92586
      Phone (951) 672-1866; Fax (855) 306-0135
    • Temecula Office: 31515 Rancho Pueblo Rd, Suite 203, Temecula, CA 92592
      Phone (951) 303-1500; Fax (855) 306-0135
    • Moreno Valley Office: 23100 Eucalyptus Ave, Moreno Valley, CA 92553
      Phone (951) 924-6500; Fax (855) 306-0135

    Medical Information Release

    If you would like to authorize the providers of Southland Arthritis to discuss your medical conditions with a relative, friend or health care surrogate, please complete the information below.

    Providers:
    Chandrakant Mehta, MD
    Amal Mehta, MD
    Dharmarajan Ramaswamy, MD
    Lisa Garcia, FNP

  • Medical Information Release

  • If you would like to authorize the providers of Southland Arthritis to discuss your medical conditions with a relative, friend or health care surrogate, please complete the information below.

    Providers:
    Chandrakant Mehta, MD
    Amal Mehta, MD
    Dharmarajan Ramaswamy, MD
    Lisa Garcia, FNP

  • This field is for validation purposes and should be left unchanged.
Contact

Phone

Hemet Office: (951)652-5000
Menifee Office:(951)672-1866
Corona Office: (951) 256-1779
Temecula Office: (951)303-1500
Riverside Office: (951)924-6500
San Bernardino Office: (909)567-2917

Fax Numbers:

(855)306-0133 - Pharmacy
(855)306-0134 - Labs, Radiology
(855)306-0135 - Authorizations