We ask our patients to complete these forms before their first appointment. Please click on the link below to download the form.  Print the form(s) and fill them out before coming for your first visit. If you have any questions regarding which forms to complete please contact our office for assistance (310) 201-0990.

These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.

For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. :  The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.