Practice Name
Specialty
City, State
Phone
Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, treatment can be performed the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.
Please assist us by providing the following information at the time of your consultation:
Your referral slip and any X-rays, CT scans, MRI films, hearing tests or sleep studies (if applicable)
A list of your current medical prescriptions
If you have medical insurance, bring the necessary completed forms and your insurance card. This will save time and allow us to help you process any claims.
IMPORTANT: A parent or guardian must accompany all patients under 18 at the consultation visit.
Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves, rheumatic fever, etc.) or if you are on any medication (i.e., heart medications, aspirin, anticoagulant therapy, etc.)
X-Ray/CT/MRI
If your physician has ordered a previous diagnostic study, you may request to have the films and results forwarded to our office. If there is not enough time, please pick them up and bring them to your initial consultation.
THOUSAND OAKS
SIMI VALLEY
415 East Rolling Oaks Drive, Suite 190
Thousand Oaks, CA 91361
Tel: 805.494.4797 Fax: 805.494.4810
1687 Erringer Road, Suite 103
Simi Valley, CA 93065
Tel: 805.494.4797 Fax: 805.494.4810