Your visit
New patient forms
Fill out your paperwork online before your first visit, and skip the clipboard in our waiting room.
- Sent securely to our office; not saved on this website
- About 15 minutes for all four
- Have your insurance card and medication list handy
Online sending isn’t switched on yet
You can look through the forms, but they can’t be sent from this website yet. Please complete them at your visit, or call (818) 859-7730.
Choose a form
Patient Registration
Contact details, physicians, insurance and an emergency contact.
Adult History
Your hearing, ringing in the ears, noise exposure, and your ear and medical history.
Benefits & Billing
Read and sign our acknowledgement of benefits and billing information.
Privacy Practices
Acknowledge our Notice of Privacy Practices and tell us who may receive your medical information.
Each form is sent to our office on its own, so you can complete them one at a time. Questions? Call (818) 859-7730. Se habla español.