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Insurance and Forms

Welcome to Sesi Signature! Currently, we are accepting only self-pay patients. Please reach out to us to learn more about our membership and Telehealth services. With our membership programs, we collaborate with compound pharmacies to ensure you receive the medications you need at cost.

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Disclaimer:

Use of this website to submit information may not be completely secure or HIPAA compliant.  The use of the Internet or this form for communication with our Company or any individual member of our Company does not establish a professional relationship. Confidential or time-sensitive material should not be submitted using this form and there is not a guarantee of a response time or a response at all, although we do our best to respond to each inquiry. Submitting this form confirms my understanding.

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Submit your forms and schedule visits securely through our HIPAA-compliant portal below on Tebra Patient Portal. (intake forms found on Tebra portal).

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Access Your Patient Portal. 
If you do not have a login yet please contact us for assistance.

Medical History

Please upload your medical history files to help us provide the most effective care tailored to your needs. This information will enable our healthcare professionals to better understand your background and facilitate a smooth consultation process.

Self Pay Services

To expedite your visit, please upload a copy of your insurance card. This will help us the provider understand your benefits to help navigate your health care and plan if needing to order labs or imaging. 

ID Proof

A valid form of identification is required for your appointment. Please upload a copy of your ID to help us maintain accurate records and ensure a more streamlined service during your visit.

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Website Disclaimer: 

The information on this website is for general information purposes only. Nothing on this site should be taken as healthcare advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, a healthcare professional-patient relationship. We do our best to keep information accurate and up to date, however mistakes do happen, and we cannot make guarantees regarding the accuracy of our information. We are not liable for any information on this website or your reliance upon it.

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Use of this website to submit information may not be completely secure or HIPAA compliant.  The use of the Internet or this form for communication with our Company or any individual member of our Company does not establish a professional relationship. Confidential or time-sensitive material should not be submitted using this form and there is not a guarantee of a response time or a response at all, although we do our best to respond to each inquiry. Submitting this form confirms my understanding.

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​2082 Michelson Drive, Suite 100

Irvine California, 92612

 

 

We are currently accepting patients in CA & NV.

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© 2025 by Sesi Signature Inc.

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