If you have a newborn, or are transferring your child(ren) from another practice we request that you complete our Patient Registration Form, Medical Records Release form, and Family Medical Hsitory Form prior to your first appointment. Please fax the Registration form to us at (818) 783-3110. If your child has been seen by other doctors, please do your best to have medical and immunization records sent to us at least 5 days prior to your child’s scheduled appointment so that our providers can review your child’s chart before that time.
Please take the opportunity to download and print the following three PDF forms. Downloading these forms requires that you have Adobe Acrobat Reader. If you do not have this software, please click here for a free download from Adobe or call the office and we will mail them to you.
Patient Registration Form
Fill in as completely as possible, sign, and fax (818) 783-3115 or mail to our office prior to your child’s visit.
Medical Record Transfer Form
If you have not done so already, please complete this form, sign it, and send it to your child(ren)’s old practice. If your child has a complicated medical history, we recommend that you also send this form to any consultants involved in the care of your child(ren).
Family Medical History Form