Patient forms
New and returning patients can find intake paperwork and consent forms here. Download, complete, and bring them to your first telehealth appointment — or email them back to our office ahead of time.
New patient intake form
Basic contact, demographic, and referral information we'll need before your first appointment.
Health & medical history questionnaire
An overview of your medical history, current symptoms, and relevant treatment to date.
Informed consent for treatment
Outlines what to expect from care at our practice, including telehealth consent.
Notice of privacy practices (HIPAA)
How your health information is protected, used, and shared with your consent.
Pre-surgical evaluation questionnaire
For patients referred ahead of spinal cord or peripheral nerve stimulator, spine, bariatric, or intrathecal drug infusion procedures.
Insurance & billing information form
Insurance details and billing preferences so we can verify your benefits in advance.
These forms are being finalized and will be available to download here shortly. If you have an upcoming appointment and need a form sooner, call our office at (818) 230-7292 and we'll send it to you directly.