East-West Integrative Medicine |
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| 3527 Ocean View Blvd Glendale CA 91208 Phone: 818.279.8199 Fax: 818.279.8181 |
Please complete forms 1-5 and MAIL to our office at least 1
week before your first appointment:
1. Registration Form
2. Consent Form
3. Health Questionnaire
Email disclaimer:
I use email for non-urgent communication with patients. Email to me should
never include any subject that requires an emergent or urgent response,
defined loosely as "I need an answer to this question right now" (if that is the
case you should be calling either me or 911). Please keep in mind the
potential for lack of confidentiality of email communication on either your end
or mine, though I make every effort to make sure that I am the only person
looking at my email. Appropriate topics for email communication include follow
up of established problems, medication refill requests (though you should
typically first check with your pharmacy, which will contact me if I need to
authorize refills), inquiries regarding test results, and non-urgent appointment
requests, and putting "(REPLY REQUESTED)" in the subject line will catch
my eye.. If I don't respond to you within 24-36 hours please send it to me
again and add "SECOND REQUEST" to the subject line.
I use email for non-urgent communication with patients. Email to me should
never include any subject that requires an emergent or urgent response,
defined loosely as "I need an answer to this question right now" (if that is the
case you should be calling either me or 911). Please keep in mind the
potential for lack of confidentiality of email communication on either your end
or mine, though I make every effort to make sure that I am the only person
looking at my email. Appropriate topics for email communication include follow
up of established problems, medication refill requests (though you should
typically first check with your pharmacy, which will contact me if I need to
authorize refills), inquiries regarding test results, and non-urgent appointment
requests, and putting "(REPLY REQUESTED)" in the subject line will catch
my eye.. If I don't respond to you within 24-36 hours please send it to me
again and add "SECOND REQUEST" to the subject line.
Please complete these forms if you are going to have an
Acupuncture treatment:
1. Acupuncture Consent Form
2. Fives Phases Questionnaire
3. Acupuncture Information Sheet
Acupuncture treatment:
1. Acupuncture Consent Form
2. Fives Phases Questionnaire
3. Acupuncture Information Sheet
Forms for First Time Visit