New Patient Health History Form

In order to provide you the best possible care, please complete this form and bring it to your first appointment. All information is strictly CONFIDENTIAL.
Patient Data

* Your email will NOT be shared with any 3rd parties, and is used for occasional office announcements and promotions.

Mailing address

We will do our best to accommodate your busy schedule.  Schedule an appointment today!

We strive to provide complete care for our patients.  Learn more about all the services we provide.


Office Hours

Our Regular Schedule

The Samaritan Medical Tower building will be closed on Saturday, July 4, and our office will therefore not be open for services.

Contact Us

1127 Wilshire Boulevard, Suite 403, Los Angeles, CA 90017

T: 212-300-2102  • F: 800-586-0181

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