Patient Forms
Most Common Forms
Click on links for the most commonly used forms. Scroll below for more.
- Orthopaedics: New Patient Form.
- Medicare New Patient Paperwork – All Appointments Effective 1/1/25.
- 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
- 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.
- All MRI and CT Scan forms can be found on this link from Imaging Specialists of Burbank - Pacific Ave.
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.
- Medicare New Patient Paperwork – All Appointments Effective 1/1/25.
- 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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“The care my 11-year old received from Omar Duenes at OSS was outstanding….as soon as Omar D. saw them (Xrays of wrist), he was able to determine that she broke her wrist. He was extremely professional, knowledgeable, and helpful. ”- DeAnna
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“Everyone here was great Came in after surgery on my dominant wrist for a fracture and after 6 weeks I am almost back to normal functionality. Jamie was my therapist and she is great. Would recommend going here. ”- Cameron H.
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“This is my second time here. First time was for me with Dr Mikael. Second time was for my daughter - she went to see Dr Mikael too. She has a broken Fibula and Tibia. The wait time was spectacular today. Fast! His nurse / RN was on it!. As soon as he came to get us he says oh no! And immediately adjusted her crutches. Took us back and proceeded to take ... ”- Veronica V.
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“Dr. Shahan Yacoubian replaced my left hip in October. I went in with full confidence because not only was I referred by my trusted physician, but leading up to the surgery I met so many others who had recently had hip or knee surgery and highly recommended him. Since my VERY SUCCESSFUL hip replacement, I've met even more of his happy patients. It just ... ”- Tina P.
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“I was expecting a big cold medical office but got a warm intimate welcome from the staff…They were well staffed: My son got x-rays done promptly. I feel very confident in Dr. Moses and when my son needed a custom splint, (they) were able to make it right away on the premises. ”- Andrea
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“Hallie, David, Hanook. Ashlee and Jessie worked with me and they were all very professional and conscientious. (ney listened to all my wrist. complaints and they would make sure my wrist would feel better, When I first came to therapy I was doubtful that it was going to help my wrist, I'm glad to say I was wrong, all the mentioned therapists made a ... ”- Rosa D.