New Patient Information

Jonathan Corren MD

Howard Schanker MD

Rita Kachru MD

10780 Santa Monica Blvd.
Suite 280
Los Angeles, CA 90025
(310) 312-5050 | Phone
(310) 575-9292 | Fax
(310) 859-6423 | After hours

What to Bring for Your First Visit

1. New patient identification form
2. New patient questionnaire
3. Insurance card
4. Name and address of your doctors
5. All medications and devices you currently are using
6. Recent x-rays, lab tests and summaries of pertinent medical
records (if you have them)

Please note that our patient forms are in Acrobat format.


Download New Patient Information Form	Download New Patient Questionnaire

To view and print these documents, you will need a copy of Adobe Acrobat Reader. This is a free program and can be downloaded directly from the Adobe Web site by clicking the logo below. Fill out the form and then fax it back to us before you come in. Fax number: (310) 575-9292