CLICK ON THE FORMS YOU NEED TO DOWNLOAD
TO AUTHORIZE RELEASE OF YOUR MEDICAL RECORDS:
- Release of Medical Records To Specific Individual or Entity
- Release of Medical Records To Insurance Company
- Release of Billing Information Form
- Request for UCLA Records to be sent to Dr Stein
FOR FINANCIAL GUARANTORS:
Please download and complete guarantor forms HERE These forms need to be completed and FAXed back to the office at (310) 740-9061 by the guarantor paying for the patient’s services at least 48 business days before the patient’s initial visit. Patients also need to make sure they complete the authorization to release billing information to the guarantor, also found in the initial paperwork.