02 Oct Update Your Patient Intake Form Before Your Next Visit
We ask all patients to update their intake form once a year and anytime their contact information or emergency contact changes. Keeping these details current ensures we can reach you about appointments and test results, reach your emergency contact when needed, and get you checked in quickly.
Download your intake form
Choose your preferred language:
When to update your form
- You moved or have a new phone number or email
- You started a new medication or have a new allergy
- You have a new emergency contact
Returning your form
Print your completed form and bring it to the front desk at your next visit. Established patients can also text their completed form to (213) 296-0120.
Questions? Call us at (213) 235-2500.
