All NEW patients are required to fill out paperwork prior to being seen in our office. Below you will find our Medical Questionnaire packet along with instructions on how to submit it. Please note that these packets are in PDF format and will require Adobe PDF Reader to view them.
- Click on the “Patient Questionnaire” form button below
- Fill in as much as you can. You can download the form and use DocuSign to fill out and sign the form digitally.
- Be sure to sign the document either digitally (via DocuSign) and email it directly from DocuSign to firstname.lastname@example.org. Or, manually sign after printing out the document, scan and email,
or bring with you to your appointment.
- Insurance Card
- Identification (Driver’s License, ID Card, or Government Issued ID)
- HMO Authorization Letter (if applicable)
How to Submit Your Forms
You have 2 ways to get us your completed forms prior to your appointment:
- Fax to 310.205.3553 prior to your office visit
- Print out and bring in your completed packet on the day of your appointment.
For a small list of insurances we do accept, please click here.
Still have questions? Need help with your forms? Call us at 310.205.3555 or 818.914.7546, email us, or click on the chat box on the right lower edge of your screen. We’d be happy to help!