WELCOME

We are beyond excited that you have decided to schedule your appointment. We are looking forward to making your visit was simple and stress free as possible. 

Revive MD Staff

NEW PATIENT PAPERWORK

You will need the following forms filled prior to scheduled appointment. For your convenience we have provided you with all of the necessary paperwork you need in order to prepare for your appointment. 

You will need:

  • HIPAA Consent

  • Photo Consent 

  • Arbitration Agreement 

  • Patient Intake

  • Patient Information  

If you have any questions, please call our office at (805) 771-8478

CONSULTATION PAPERWORK

HIPAA Consent 

Patient Intake

Photo Consent 

Arbitration Agreement 

Patient Information

Patient Information

Skin Assessment

HIPAA Consent 

Coming in for one of our complementary consultations? In order to help prepare for your appointment, we have provided the paperwork in advance for your appointment. 

You will need:

  • HIPAA consent form

  • Skin Assessment 

  • Patient Information

If you have any questions or wish to fill out your paperwork at the office, please inform us at the time of your appointment and we will extend your appointment to reflect.

CONTACT DR. LALEH SHABAN

Revive MD Medical Group

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4251 S. Higuera St. Ste 600

San Luis Obispo, CA 93401

PH: (805) 771-8478

FAX: (805) 852-2533

Revive MD Medical Group

4251 South Higuera St. Ste 600
San Luis Obispo, CA 93401
(805) 771-8478

© 2017 by REVIVE MD MEDiCAL GROUP

Hours of Operations:

Monday: 9 AM-5 PM

Tuesday: 9 AM - 5 PM

Wednesday: 9 AM - 5 PM

Thursday: 9 AM - 5 PM

Friday: 9 AM - 6:30 PM

Saturday: 9 AM - 6:30 PM

Sunday: Closed