Patient Forms & Fees

New Patient Forms

Save time at your appointment by filling out your patient forms ahead of your visit. Click on the links below to view and print forms.

• Patient Registration Form
• Patient History Form
• Review of Systems
• Financial Policy
• Patient Record of Disclosures
• Patient Information Release
• Authorization to Treat Minor
• Physical Examination Form / Pre-Operative Examination Form
• Patient Rights & Responsibilities
• Notice of Privacy Practices

Completing Forms for Our Patients

We are pleased to assist our patients by filling out any necessary medical forms in a timely manner, including:

• Disability forms
• Family and Medical Leave Act (FMLA) forms
• Insurance forms
• School, sports and camp forms

Please note that there will be a charge to have forms filled out based on form length, as follows:

• Each form less than 4 pages: $15
• Each form that is 4 pages or more: $25

Completion of forms typically takes 3 to 4 business days. For more information, please call our office at 818-382-6400 or contact us today.