East-West Integrative Medicine |
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| 3527 Ocean View Blvd Glendale CA 91208 Phone: 818.279.8199 Fax: 888.584.9315 |
Please complete forms 1 through 5 and MAIL them to our
office at least one week before your first appointment:
1. Registration Form
2. Consent Form
3. Health Questionnaire
4. Credit Card Form
5. Non-Covered Benefit Fee Form
Email disclaimer:
We use email for non-urgent communication with patients. Issues requiring
an immediate response should be handled by calling the doctor, or by calling
911. While we make every effort to maintain the confidentiality of our
patients, email messages are, by their nature, unsecured. Therefore, email is
not appropriate for all topics. Suggested use of email includes:
the subject line. We make reasonable efforts to respond to emails promptly,
however, if you do not receive a response within 24-36 hours, please re-send
the email with the words "SECOND REQUEST" in the subject line.
We use email for non-urgent communication with patients. Issues requiring
an immediate response should be handled by calling the doctor, or by calling
911. While we make every effort to maintain the confidentiality of our
patients, email messages are, by their nature, unsecured. Therefore, email is
not appropriate for all topics. Suggested use of email includes:
- follow up of established problems
- medication refill requests (note: please consult your pharmacy first and
they will contact us for refill authorizations) - inquiries regarding test results
- non-urgent appointment requests
the subject line. We make reasonable efforts to respond to emails promptly,
however, if you do not receive a response within 24-36 hours, please re-send
the email with the words "SECOND REQUEST" in the subject line.
Please complete these forms if you are going to have an
Acupuncture treatment:
1. Acupuncture Consent Form
2. Five Elements
Acupuncture treatment:
1. Acupuncture Consent Form
2. Five Elements
Forms for First Time Visit
reader to read these files. You may obtain the reader here.
The documents below are for your information. Please read: