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Call: 818-774-0955

Patient Forms

Download & Complete

Patient Forms

Forms to Download

New Patient Information Form – EnglishDownload
New Patient Information Form – SpanishDownload
Visit Questionnaire Form – EnglishDownload
Visit Questionnaire Form – SpanishDownload
Visit Us

To save you time and streamline your visit, we provide all necessary patient forms online. You can download, print, and fill these out at home, or simply review them ahead of your appointment. Bringing completed forms to the clinic means less paperwork in the waiting room and faster check-in.

Filling Out Forms at the Clinic: If you choose to fill out forms in our office, that’s completely fine too. Arrive about 10–15 minutes before your scheduled appointment (or factor in a bit of extra time if you’re a walk-in) to complete the paperwork. Our staff will provide you the forms on a clipboard. If you need assistance – for instance, translation help in Spanish or Russian – our bilingual team members are happy to assist.

If you have any questions about what a form is asking, just ask us. We want to ensure all information is accurate and that you understand what you’re signing.

Why These Forms Matter:
Providing thorough and accurate information on your patient forms helps us take better care of you. Knowing your medical history, current medications, and any allergies or past surgeries ensures we avoid any treatments that conflict with your background. It also speeds up the process – our providers can quickly review your history rather than asking everything from scratch during the visit. Rest assured, all information you provide is kept confidential as part of your medical record.

Updating Your Information:
If you’re a returning patient and something has changed (like you have a new medication, or your insurance changed, or you moved to a new address), please let us know at check-in. You might not need to fill a whole new form – we can often update specific details in our system and have you initial the changes. We may ask you to review and update the Medical History form annually to keep our records current. Having these forms completed ahead of time means when you arrive, you can focus on getting the care you need rather than doing paperwork. You can find the downloadable forms [here on our website] (in this Patient Forms section). If you encounter any issues accessing or printing the forms, feel free to contact us and we can email or fax them to you, or have a copy ready for you to pick up.

Forms Available for Download:

  • New Patient Registration Form: Basic information about you, such as name, date of birth, contact info, and emergency contacts. This form also asks for any existing medical conditions, allergies, and current medications so we have your health background.
  • Medical History Questionnaire: A more detailed form where you can note your past illnesses, surgeries, hospitalizations, and family medical history. This helps our providers understand your health context and provide the best care.
  • Consent to Treat & Financial Policy Form: This form explains your consent for us to provide treatment and outlines our privacy practices and payment policies. It includes the HIPAA acknowledgement of privacy practices, indicating that you’ve been informed about how we protect your health information.

How to Use the Forms

  • Simply visit our Patient Forms section on the website (you’re likely already here if you’re reading this content).
  • Each form or packet is provided as a PDF file. 
  • You can click the link to open it or right-click to save it to your computer. Then, print the forms and fill them out with pen. 
  • If you don’t have a printer, you can come a few minutes early to the clinic and fill out copies in person – we have plenty on hand.
Call 818-774-0955