New Patient Packet – Required of all new patients

Note 1: Our New Patient Packet must be downloaded, completed, and returned to our office using the instructions below before we'll be able to schedule your first appointment.

Note 2: Please read our General FAQs and our Health Insurance FAQs before downloading and beginning work on your New Patient Packet. Making sure we’re the right fit for you and your healthcare includes reviewing the health insurance plans we accept at Restoration Healthcare.


(please follow the below instructions for accessing, filling out, and returning your New Patient Packet)

  1. Download the New Patient Packet by right-clicking on the image to the right (below for mobile) and selecting "Save Link As."
  2. Save the file in a private and secure location on your computer. . When saving, please be sure to place your last name at the beginning of the file name
    example: if your last name is Smith — "Smith_RH_New_Patient_Packet.pdf")
  3. For best results, please use the latest version of Adobe Reader to open and work on your New Patient Packet. (Mac users: While it is possible to work on this file using the Preview program on your Mac, it is NOT advisable. Please use Adobe Reader instead.)
  4. Once you're ready, start to answer all questions presented in the document. Fill in all the banks starting with the General Information part in Section I on Page 2.
  5. Please Type all of your responses — DO NOT HANDWRITE your responses.
  6. For multiple choice questions, please check the corresponding box that applies.
  7. Don't forget to Save the file while doing your work.
  8. Once all questions are answered, please save the PDF file one last time, and then attach the file to a new email message that you send to:

    [email protected]

    Important: Put "New Patient Packet for (place your last name here)" in the subject line of your email message, along with the following information in the body of the email message itself:

    "The attached New Patient Packet is from (insert your first and last name here). My phone number is (insert your phone number here). Please review my packet and then call me to schedule my first appointment.)"

Additional Information for New Patients

If you’ve landed on this page, that means one of two things: You’re either considering us as your healthcare provider or you’re getting ready for your first office visit. Regardless of what brought you here, there are four things we’d like you to know:

  1. We’re glad you’re here!
  2. We use data and facts to help create your treatment plan, which is why we need your help in completing the New Patient Packet.
  3. We actively partner with you to discover and help you overcome chronic conditions preventing you from a living a long and healthy life.
  4. For most cases, six months is the best amount of time for us to work together to get you back on track.

What to Expect During Your First Appointment

During your first appointment, our medical team — led by Restoration Healthcare's medical director, Dr. Sunny Raleigh, and our practice founder and president, Dr. Thomas Bakman — will review with you your responses to the questions posed throughout your completed New Patient Packet. We’ll also take time to review your health-related goals and objectives, and then spend time discussing tests and possible treatment options. Please allow 90 minutes for your first appointment and try to arrive 15-20 minutes early so you have plenty of time to park and get comfortable in our surroundings.

If you are a new or first-time Restoration Healthcare patient, you MUST download, complete and send back to our office your New Patient Packet before we will be able to schedule your first appointment. If you are unable to download and/or complete the New Patient Packet electronically, you may pick up a hardcopy of the Packet at our office, or we can mail you one. Please call our office to make arrangements: (949) 535-2322.