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New Patient Forms
When you contact the Skull Base Institute you may be asked to provide information contained in our "New Patient Packet". The packet can be sent by mail or you may choose to download copies of the forms online. In either case please provide the requested information and mail the forms or bring them with you to:
Skull Base Institute
8635 West 3rd Street
Suite 1170W
Los Angeles, California
90048
Please click on each form to view the document. It should automatically open Adobe Acrobat and display the form in .PDF format. Print each form and fill in the information requested.
The downloadable forms are:
- Patients Welcome Letter
- Patient Rights and Responsibilities
- Health Questionnaire
- Medications To Be Avoided Three Weeks Before / After Surgery
- Demographic Sheet
- Driving Directions To The Skull Base Institute
- Hotel / Motel List
- Map
When you visit our offices you will receive a second packet containing the following. These are not available for downloading.
- Authorization To Release Medical Documents
- Confirmation Of Receipt Of Documents
- Consent For Treatment And Billing
- Credit Card Payment Data Sheet
- Notice Of Privacy - Parts 1 and 2
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