New Patient Packet

The New Patient Packet contains forms which must be completed prior to seeing the clinician. Two of the forms must be returned to MCLA at least 3 days before the appointment. Please follow the instructions carefully and remember to bring the requested items.

Click here for New Patient Packet


Download Instructions:

  • Open the document
  • After the form is open, right click your mouse and click "Save As" - save the form to your Desktop. Choose a file name you will remember e.g. MyInformation.pdf.
  • Once you have saved to your desktop, exit this website and click the MyInformation.pdf on your desktop.
  • You can now begin filling in the document.
  • Once completed, go to the menu at the top of Acrobat Reader and click "File" At the dropdown menu click "Save As."
  • Save the form to a folder or directory of your choice. We suggest adding the current date eg. MyInformation-4-10-17.pdf. Adding the date lets you know which information is most current.
  • Once saved, click the letter icon in the top menu and follow the on screen instructions to email.
  • attach to an email and send to:
  • If you prefer you can print the pages and fax to: (818) 545-7672.

    Please Note:  Typing your name to the pages in this document makes this document legal and binding.

Medical Records Release

To request release of your medical records from MCLA to a third party, download this form and bring it with you to the office.

Click here for Release of Information by MCLA

Authorization Form

You may use this form to authorize having your records sent to MCLA.

Click here to have your records sent to MCLA