New Patient Forms

Make an Appointment

To make an appointment, please call 310-657-4080, or click here to make an online appointment. Please inform our staff of all your issues when making an appointment so we can allot the appropriate amount of time for your conditions.

Insurance

Most insurance plans are accepted. Insurance verification is recommended prior to appointment. Call our office with your questions. If you are unsure whether we are a preferred provider, call your insurance Member Services number usually located on the back of your card.

Bring to First Appointment

Insurance card(s)
Names of other doctors
Current medications or list of medications and dosages
Patient forms (see below to download)
Recent medical records or x-rays (may save you time and charges especially if seeking a second opinion or transferring care)

When to Arrive

Please arrive 15 minutes before your scheduled appointment time to complete any forms. We strive to stay on schedule and value your time. New patients may require as much as 30 minutes for their initial evaluation depending on their condition.

Patient Forms

Instructions

Click on the links below to access the New Patient Forms (Word doc or PDF depending on what you prefer).

After you click the link, a browser window will open and you will be able to fillout each section.

Depending on your browser, you may need to download forms to your Adobe Reader to fill them out.

After filling out forms, click on the 'PRINT' icon and bring forms to your first appointment.

You may alternatively print the forms, fill them out by hand, and bring them to your first appointment.

Completing the New Patient Information Forms will save you time on your initial visit!

If you have trouble printing, or do not have access to a printer, please arrive 15 minutes early to complete forms.

You must have an Acrobat Reader to download the Acrobat files.

To use the Word docs, you must have Microsoft Word. If you are using a smart phone or tablet (ipad), please open the PDF version of the form.

If you don’t already have Adobe Acrobat, you can download the Acrobat Reader free by clicking here.

BHF&A

New Patient?

Make an Appointment

Insurance

Bring to First Appointment

When to Arrive

Patient Forms

Instructions

New Patient Registration Form

HIPAA Notice of Privacy

Credit Card Consent Form

Medical History Form

HIPAA Privacy Acknowledgement

Financial Policy

Email Consent Form

Site Links

Location

Contact