Appointment Request

Map & Directions

Patient Forms

Please fill out the following forms, print them out, and bring them with you on the day of your appointment. We will also provide these forms to fill out if they are not complete prior to your scheduled consultation.

Please refer to our office link to see a list of our insurance carriers.

    1. Patient Information

    2. Patient Medical History

    3. Notice of Privacy Practices 

    4. Arbitration Form - choose one:

        a. Arbitration Form (English)

        b. Arbitration Form (Spanish)

        c. Arbitration Form (Vietnamese)

The following link will provide your rights: Patient Privacy

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

Directions

Our office is in the last mirrored building in front of the Palm Island Adult Community Center, next to the Fountain Valley Regional Hospital. Major Cross streets are Euclid and Warner.

From 405 South

• Exit Warner Avenue - East
• Pass Euclid (after about 4 lights)
• Building is on right side before Mt. Hope Street
• Turn right on Mt. Hope to access the parking lot

From 405 North

• Take Euclid Exit
• Turn left on Euclid
• Pass Slater (after about 4 lights)
• Turn right on Warner (@ Fountain Valley Regional Hospital sign)
• Building is on right side before Mt. Hope Street
• Turn right on Mt. Hope to access the parking lot

From 22 East

• Take Euclid Exit
• Turn right on Euclid
• Pass Edinger ( about 3 miles)
• Turn left on Warner ( at the end of Mile Square Park)
• Building is on right side before Mt. Hope Street
• Turn right on Mt. Hope to access the parking lot

From 22 West

• Take Euclid Exit
• Turn left on Trask
• Turn on 1st left onto Euclid
• Pass Edinger ( about 3 miles)
• Turn left on Warner ( at the end of Mile Square Park)
• Building is on right side before Mt. Hope Street
• Turn right on Mt. Hope to access the parking lot

Questions or Comments?

We encourage you to contact us whenever you have an interest about our services. Contact us with the form to the left.