Are you a New Patient?

Welcome to our New Patient Intake Forms page.
If you have problems accessing our forms or using this page, please call
818.445.3639.

1.  Click
here to download and print your forms.
Remember to use black ink when completing them.

About the forms:
Case History - Top section only; we already have your
insurance information.  Sign and date at very bottom.
Review of Systems - Series of boxes, simply check off whatever applies to
               you.
Pain Diagram - Please complete section above thick black line only.
         Sign and date.
Informed Consent - Print, sign and date.
HIPAA Privacy Policy - Print, sign and date.
Assignment of Benefits - Print, sign and date.
Cancellation Policy - Print, initial, sign and date.

2.  When you've completed the forms, please email
them back to
Genesis Health Group so that we can
continue with your screening process.

3.  You're ready to schedule your first appointment!
To do this, go to
http://seethebook.ucoz.com.
Select the day and time best for you.  
Please note that the scheduling site is not interactive.

4.  Call/Email/Text your selection to Genesis Health Group so that
we can schedule you in as soon as possible.

Thank you for choosing us, and we look forward to being of service to you.