Now accepting Telehealth appointments. Schedule a virtual visit.

Patient Form


 

Save time in the office by completing your patient forms prior to your visit. Please fill out all four forms.

 

Medical intake form

 

Medical History Form

 

Authorization for release of medical records

 

SkinPen Patient Consent Form

 

Location

Los Angeles Primary Care
1711 West Temple Street, Suite 4691
Silver Lake

Los Angeles, CA 90026
Phone: 213-320-0657
Fax: 213-444-7212

Office Hours

Get in touch

213-320-0657