5363 Balboa Boulevard, Suite 540 · Encino, CA 91316
EMAIL firstname.lastname@example.org · PHONE 818.905.6600 · FAX 818.905.6610
If you are a new patient, please fill out the new patient paperwork before your appointment and email it to email@example.com Please call us at 818.905.6600 if you have any questions about any of the forms, or about anything else prior to your appointment. We are happy to help.· We call to confirm all appointments 2 days prior to the day that you are scheduled. Please keep in mind this a courtesy call, and it is still the patient's responsiblity to remember when appointments are made. · If you need to cancel or reschedule appointments, please let us know 24 hours in advance. There will be a $100 cancellation fee for any last minute cancellations the day of the visit/procedure.
Patient Registration Form / Forma de Registro Paciente: