New Patient Packet
The New Patient Packet contains forms which are to be completed prior to seeing the clinician. The forms must be returned to MCLA 5 business days after you have secured your appointment. If you are unable to return the forms within 5 business days, call the office to make other arrangements. Please follow the instructions carefully and remember to bring the requested items.
Click here for New Patient Packet
Instructions
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.
- Print your completed form
For your security please bring your completed Form to the office or 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
Instructions
Download Instructions:
- Download and print document.
- Manually fill in all fields
- When finished print out document
For your security please bring your completed Form to the office or print the pages and fax to:
(818) 545-7672.
Authorization Form
You may use this form to authorize having your records sent to MCLA.
Click here for Authorization Form
Instructions
Download Instructions:
- Download and print document.
- Manually fill in all fields
- When finished print out document