Thank you for your interest.
After scheduling your appointment using the online scheduling system, please download, complete, and return the following 3 New Patient Intake Forms within two business days.
New Patient Information
Consent to Receive Services
Arbitration Agreement
INSTRUCTIONS
1. Schedule your appointment using the online scheduling system.
2. Return the above 3 forms by fax and/or email within 2 business days. If your completed forms cannot be reviewed and approved, your appointment cannot be confirmed.
Fax: 510-225-3873
Email: info@shiramillermd.com (requires scanning capabilities)
3. Send the original forms by regular mail to the address below.
Shira Miller, M.D.
1240 Powell Street, Suite 2A
Emeryville, CA 94608
Notice - Appointments are usually confirmed within 2 business days. However, if you do not fax or email your forms, it may take up to 2 weeks to confirm your appointment.