Patient Services

New Patients-What to Bring to Your Appointment

Please arrive 15 minutes prior to your appointment.

Please bring your insurance card, driver’s license, or other picture ID, along with the co-payment for your visit.

Please complete the Medical History Information Form.

Please bring a list of your current prescriptions, including any over-the-counter medications you are currently taking.

Important: Your appointment with Harbor-UCLA Faculty Practice Plan is not a guarantee of coverage. We highly encourage you to confirm coverage with your health insurer prior to your appointment.

If you are an HMO patient, you will require prior authorization from your health plan or medical group to be seen by one of our doctors. 

 

 PATIENT FINANCIAL RESPONSIBILITY WAIVER.pdf
   PEDS AUTHORIZATION TO RELEASE INFORMATION.pdf
   SPANISH MEDICAL HISTORY INFORMATION FORM.pdf
   SPANISH PT FINANCIAL RESPONSIBILITY WAIVER.pdf