Patient Forms
Most Common Forms
Click on links for the most commonly used forms. Scroll below for more.
- Orthopaedics: New Patient Form.
- Therapy Services: New Patient Form and I have Medicare.
- Therapy Services: New Patient Form and I have a Private Insurance Insurance (e.g., PPO).
Orthopaedic Department
I am a returning OSS patient, but:
- It has been 3 or more years since I was last seen at OSS.
- I need a new orthopaedic provider.
- I have been seen by this doctor before but have a new problem.
- I have changed my health insurance plan or provider.
Pain Management (Dr. Chrystina Jeter)
- NEW PATIENT: I am new to OSS and to Pain Management.
- I am a returning OSS patient, but new to Pain Management.
Imaging (MRI, CT Scan, Bone Density)
- NEW PATIENT: I am new to OSS and to Imaging.
Please complete this form PLUS the relevant form below.
I am a returning OSS patient, but now:
Therapy Department
Includes physical therapy, hand therapy, and chiropractic.
- NEW PATIENT: New to OSS Therapy and have Medicare.
- NEW PATIENT: New to OSS Therapy and have Private Insurance (e.g., PPO).
- NEW PATIENT: New to OSS Chiropractic.
Additional
Read What Our Patients Say
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“I was suffering from an excruciating lower back pain that prevented me from doing any movement, except for standing and walking. After getting an MRI I was told by my Orthopedic Surgeon I had a 7mm herniated disc on my L5, Physical Therapy would not help, and my only options were to either get an epidural injection for a temporary pain relive or another ... ”- Anashe M.
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“Great Facility! Dr. Moses is perfection. ”- Tom M.
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“So back in April I was involved in a nasty bike accident that left me with a severely broken arm. 10 days in the hospital and 4 surgeries later I'm released to start the slow process of recovery. By the time my last surgery had finished and healed, could barely move my wrist, turn my arm, open my hand, or use my fingers. I was told by my surgeon that I ... ”- Eric R.
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“Dr. Stephan V. Yacoubian is the best! He is knowledgeable, specific, and treats with care and patience. I have had my left & right shoulder surgically repaired after two unfortunate accidents and never looked back. It’s a been a dream come true. ”- Maxine W.
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“Got an appointment the very next day after breaking my leg. Thank the doctor at Burbank Urgent Care for calling over the referral. Everyone was very professional and compassionate. The PA and his assistant, Brian, were great at casting my leg with safety and comfort. What a relief! ”- Sai-Ling M.
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“I think Orthopedic Surgery Specialists group is the best group for orthopedic surgery. Over the years, before OSS, I had two knee surgeries, a shoulder surgery, and a foot surgery with different doctors and at different facilities. So I have had a lot of orthopedic experience. I discovered OSS this summer after a MRI revealed I had a broken hip. Dr. ... ”- Janet L.