1245 Wilshire Blvd.
Suite 603
Los Angeles, CA  90017
(213) 977-1215
fax (213) 977-0404
Hours: M-F 9:00-5:00
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Copyright© 2010
LA ENT, Associates.
All rights reserved.

Office Forms

This page lists all the forms that need to be filled out in or office prior to your appointment.  Please fill out as much as you can before your appointment.  The forms are in PDF format.  If you do not have Adobe® Reader®, you can download it for free.  Click on the image below for the download.





You will still need to arrive at least 15 minutes before your appointment in order to copy your insurance cards, collect any co-payment and to make your file.


Please select the link below, print out the page and use your back arrow to return to this page.

New patient forms (all 3 forms need to be completed for new patients): Our Notice of Privacy Policy can be found here.  Please read it and bring the completed form listed below:
  • Acknowledgement of Receipt of Notice of Privacy Practices

If you need to send or transfer medical records, please print out our release form:

Authorization to Release Medical Records


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