New Patient Forms & Notices

If you are a new patient of ours, there are important forms to complete to get started with us. For your convenience, all forms located below can be completed electronically. Please print your completed forms and submit them to our office staff at your scheduled appointment for processing. If you have any questions about any of the items on the forms, our office staff can assist you during your visit. Additionally, the notices listed below are for your reference only. We encourage you to review them at your earliest convenience as they have valuable information about our operations.

New Patient Forms

Patient Registration Form

Adult Health Assessment Questionnaire

Pediatric Health Assessment Questionnaire

Acknowledgement Form

Authorization to Allow Disclosure of PHI

Consent for Medical Treatment of a Minor by “A Qualified Adult Relative”

Authorization to Consent to Treatment of a Minor

Patient Portal Enrollment Form


Notice of Privacy Practice

Financial Policy

COVID-19 UPDATE: Restricted visitor policy. COVID-19 line (626) 397-3777. Learn how you can help. Please, no donations of food.  >> READ MORE