David Kan, M.D.
  • Introduction
  • Fees
  • Services
    • Psychiatry and Addiction
    • Telemedicine
    • Speaking Engagements
  • Patient Forms
  • Contact
  • Forensic Consulting
  • Policies
Patient Forms

Intake Forms for New Patients:
  1. New Patient Form PDF - fill this form out before your first appointment. You can email to david@davidkanmd.com or fax to (925) 407-2783
  2. New Patient Form Word - Microsoft Word Formatted -fill this form out before your first appointment. You can email to david@davidkanmd.com or fax to (925) 407-2783
  3. Notice of Privacy Practices – to inform you of your rights to protect your personal health information
  4. Consent for Release of Info - to authorize your doctor to collaborate with your treatment team and provide you with the best medical care

Forms for All Patients:
  1. Credit Card Authorization - kept securely on file for all patients
  2. Medical Records Release Form

    To request an appointment

Submit
David Kan, M.D., D.F.A.S.A.M
Addiction, Forensic, and General Psychiatry
2960 Camino Diablo, Suite 100
Walnut Creek, CA 94597
Email: david@davidkanmd.com
Phone: (925) 953-2833
Fax: (925) 407-2783
  • Introduction
  • Fees
  • Services
    • Psychiatry and Addiction
    • Telemedicine
    • Speaking Engagements
  • Patient Forms
  • Contact
  • Forensic Consulting
  • Policies