In preparation for your upcoming appointment, please download ALL these new patient forms or pick them up from the clinic.
You must complete and return ALL the forms to VCH by 12 noon on the business day (Mon-Fri) before your appointment, or your visit will be rescheduled to a later date.
Drop off your FIVE completed forms at the clinic, email them to [email protected], or fax them to 818-301-6354.
Please do not submit medical patient information to [email protected] as your information is not secure.
Registration Forms
General Consent Forms
Telehealth Consent Forms
Medical Record Request
Late Arrival Policy
Advanced Directive Acknowledgement
Registration Form
These forms are for new patients to complete. Please print the form, fill it out, sign your name and bring to your clinic appointment.
English
Español
General Consent
This form provides consent to the treatment and services provided by VCH. Please print the form, fill it out, sign your name and bring to the clinic.
English
Español
Telehealth Consent
This form provides consent to receive telephone or video visits provided by VCH. Please print the form, fill it out, sign your name and bring to the clinic.
English
Español
Confidential Health Questionnaire
Complete this form to give us more details about your health. Please print the form, fill it out, sign your name and bring to the clinic.
English
Español
Medical Record Request
Complete this form to ask for your medical records. Please print the form, fill it out, sign your name and bring to the clinic.