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Secure medical intake

For new and existing patients, to complete before your visit with Dr. Muran.

  • Takes about 5–10 minutes.
  • Your answers go securely and privately to Dr. Muran's office, in our HIPAA-protected patient system. They are not stored on this website.
  • Mostly checkboxes: only your medications and allergies need typing.
  • Best done in one sitting. If you have to stop, call us and we will help you finish.

Questions or need help with the form? Call us at (949) 899-5377. How we protect your health information: Notice of Privacy Practices.

Your medical history

Trouble seeing the form? Open it in a new window or call us at (949) 899-5377.