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Sylmar Medical Center

Patient Registration Forms

New Patients

To help reduce your waiting time, you can print and complete the below forms prior to your office visit. Please bring them with you on the day of your appointment. Please complete all forms.

1. Patient Registration
2. Patient Registration (Spanish)
3. Patient History
4. Patient History (Spanish)
5. Notice of Privacy Practices
6. Notice of Privacy Practices (Spanish)

Medical Records Release Form

Your medical records are completely private. To ensure patient confidentiality, and conforming to HIPAA regulations, no information regarding your condition will be released by this office to anyone, including any family member, without your written consent.

1. Medical Records Release Form
2. Medical Records Release Form (Spanish)

We accept most health insurance plans

Aetna, Beech Street, Blue Cross/ Blue Shield, Cigna, Humana, Medi-Cal, Medicare, PHCS, Tricare, United Healthcare

Please note this is not a complete list of all the insurance plans that we participate with and are subject to change. Please contact our office for more information or contact your insurance carrier.

Payment for Co-pays and Self-pay patient charges is expected at the time of service. For your convenience we accept Cash, personal checks, Visa, and MasterCard