Patient Forms for Dr. Schneider


Thank you for choosing Dr. Schneider for your endocrinology care needs. We are dedicated to providing the highest standards of care by offering the most technologically advanced treatments available tailored to the needs of each individual patient.

Please read the following patient information for your upcoming visit with us.

  • Our office will need a completed “Patient Information and Consent” form for ALL new patients.

  • New adult patients will also need to complete the “Adult Health Questionnaire”.

  • If you are not yet 18 years of age at your first-time office visit, we will ask you to complete a “Pediatric Health Questionnaire” as well as the “Patient Information and Consent form”.

What to Expect During Your First Visit
Endocrinology involves evaluation of hormones. This testing requires blood. During your evaluation, obtaining a blood sample will be requested, this may be done in our office or at one of our lab partners close to your home (Quest or LabCorp).

People with diabetes are kindly requested to bring in their blood glucose monitors, continuous glucose monitors (CGM) and insulin pumps - these devices will be donwloaded in the office for a comprehensive evaluation. For subsequent visits we can set you up with one of the upload portals (Carelink, Glooko, Tidepool, etc) which enables you to upload your devices at home and share data remotely with Dr. Schneider. 


It is important that you are prepared for the visit. In addition to testing of blood and urine, it is important that you are prepared for a full examination.

  • Pediatric patients will have a complete physical examination to determine pubertal/developmental staging.

  • Men with concerns of testicular dysfunction often need genital and prostate exams.

  • Women with abnormal hair growth or breast secretions, may need evaluation of the breast and/or genitalia and we will make sure to have a female chaperone in the room during the exam.

Completing Your Patient Forms
All forms are provided for new patients at our office, however, it does take a bit of time to complete them. For your convenience, you can complete these documents online or download and print them from this website and complete them at home to bring to your first office visit. Due to legal requirements, please sign and date these forms in person during your office visit.

Please click on the form you need to download and print:

XIMED - Scripps Memorial Campus

9850 Genesee Ave, Ste. 415 

La Jolla, CA 92037

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Gateway Medical Center

15721 Pomerado Road

Poway, CA 92064

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