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Release of Medical Records

All medical records require a signed form for release and can take time to release.  Please be specific about the information that you would like to release. There may be a processing fee for records.

Medical Records Release to Us

Send us records by signing a release from your doctor to release your records to us.  You can also download the release form available on this website, sign it and send it to us. We will forward it to your doctor. This allows your records to be forwarded to us.

Medical Records Release 

If you would like your records released to another Doctor, organization, or other entity, please sign the form below and send it to our office. You can also have the other party fax us a release of records to (714)738-1352.

HIPAA and Patient Financial Forms

HIPAA, or the Health Insurance Portability and Accountability Act of 1996 addresses the use and disclosure of a patient's health information. For more information refer to:
Patient Financial Policy Notification Form
Our patient financial policy notification form explains some of the common terms in medical insurance billing and our policies regarding no-show appointments and cancellations.

Telemedicine Consent

This document explains some of the laws regarding telemedicine including payment, right to receive in-person care.

Patient Information

This blank form has data about your personal and insurance information. We strongly suggest that you do not e-mail this information into us. Please fill out the form and bring it into our office.

Pain Status Form

This form contains information about the status of your pain and function.
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