New Patient Forms
When scheduling a New Patient Appointment, there will be a non-refundable $200 deposit required to hold your appointment. Prior to your appointment day, please complete the New Patient Forms below and bring them in on the day of your appointment. This will significantly shorten your waiting time at the office and make your visit more relaxing and timely. For questions regarding insurance or financing, please review our current Payment and Financing options or call the office at (310) 939-9800 and we will be happy to answer any questions.
- Bring your current Driver’s License.
- If you have any outside reports or records you would like us to review, please request them from that office and bring them to your visit with us.
- Dependents under the age of 18 should be accompanied by a legal guardian
- Please review our Notice of Privacy Practices.
- Please also review this sample Physician-Patient Arbitration Agreement as you will be asked to sign it in the office upon your first visit.
Or if you prefer to download the forms individually:
- Patient Demographic and Medical History Form (2 pages)
- Privacy Acknowledgement and Consent
- Financial Policy and Agreement
- Cosmetic Questionnaire (optional)
If you have any questions or concerns with any of the above, our team will be happy to answer them on the day of your appointment with us. We look forward to seeing you!