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Firouz Orthodontics
(Maurice Firouz, DDS)

Call Us: (310) 447-5790
Address: 11645 Wilshire Blvd Suite
1060 Los Angeles, CA 90025
Monday – Friday 9:30AM – 5:30PM

If you are a NEW PATIENT to our office, or an EXISTING PATIENT (who either has not been seen by us or has not signed/filled out one or more required forms in a year or more), there is paperwork you will need to complete before your appointment.  Please know that we understand your time is valuable, so we only use those forms required by law or those which provide us with information needed to treat you most appropriately and effectively.

In order to give you the option of filling out the necessary paperwork in the comfort and privacy of your own home (instead of our waiting room), you will find all necessary forms below.  Or, if you prefer, we can mail these forms to you.  Just let us know which method you would prefer.

If you choose to download these forms, please print them, fill them out clearly and carefully and bring them with you to your next appointment.  This will allow us to attend to your medical needs more quickly, once you arrive.

Please note that several forms are scanned images and may take a minute or so to download, depending on your connection speed.

NEW PATIENTS: (Please download ALL 4 forms, fill out and sign)


EXISTING PATIENTS:

If it has been a year or more since you’ve been to our office, or since you have filled out and signed one or more of the following forms, please download the appropriate form(s) below and bring to your next visit:
•Medical History  (must be updated every 2 years)
•HIPAA (your federal privacy rights and options)
•Financial Policy