Patient Information

First Time Patients

• MAKE SURE PAPERWORK HAS BEEN FILLED OUT
• BRING INSURANCE CARD AND PHOTO ID (SUCH AS A DRIVER’S LICENSE)
• BRING A LIST OF ALL MEDICATIONS YOU ARE CURRENTLY TAKING
• IF YOU MUST CANCEL YOUR APPOINTMENT, PLEASE NOTIFY US 24 HOURS IN ADVANCE

Insurance

We also participate with many insurance plans. Please call our office for more details.

A note about insurance: We understand that insurance plans can be a challenge to understand. We are contracted with most PPO plans but each insurance company can have literally hundreds of plan options, and they are always changing. So, IT IS YOUR RESPONSIBILTY to confirm that we are listed as an in-network provider on your plan. Our individual doctors may not be listed, but the TAX-ID, 95-3865023, will be. If we are not listed, we are happy to see you out-of-network, and you can be a self-pay patient. We will do our best to help you with your specific situation when you call for an appointment. We try to be as transparent as possible about pricing at the time of your visit so we can limit any surprises.

Payment Options

For your convenience, we accept cash, check, Visa, Master Card and American Express.

To make a credit card payment by phone, please call our billing office at 818.918.5550. For your convenience, we also offer e-statements and accept secure, online credit card payments through InstaMed.

Patient Forms

The following forms can be filled out online and submitted via the patient portal links below. Please send additional records or inquiries to office@cffmla.com. By filling out these forms ahead of time and submitting them through the patient portal, you will save a significant amount of time during your visit.

• Financial Policy – Read Only
• Notice of Privacy Practices (HIPAA) – Read Only
• New Patient Registration
• Family History Questionnaire
• Authorization for Disclosure
• Acknowledgment of Receipt of Financial Policy & HIPAA
• Acknowledgment of Receipt of Open Payments Discloser

For patients having Genetic Counseling, please download and fill out the forms below and email them to office@cffmla.com.

• • Patient Information & Pregnancy Questionnaire
  • Patient Rights & Obligations
  • Billing Form (Genetic Counseling)

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader logo.