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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“My visit with Dr. Feldman was wonderful. He was very thorough (and) explained what the cause of my back pain might be. ”- Maragaret
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“Shahan Yacoubian and his associate team of surgeons/specialists are top natch in their field. Not only are they extremely knowledgeable in what they do, they are assertive, friendly and understand the needs of each Individual patient. My hip joint replacement went like clockwork, and exactly as they proposed it would be. After suffering sciatica for ... ”- Justin S.
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“They evaluated me carefully, always listen to my feedback, and adjusted workouts to see my progression, and in the end, I was able to be discharged from treatment and return to my normal activities earlier than planned. I definitely built more strength in the program than I had before, and feel confident that I can continue building strength at home with ... ”- Brain M.
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“My son got x-ray's done promptly, I felt very confident in Dr. Moses and when my son needed a custom splint made they were VERY helpful in making it right away on the premises and boy does it look good ”- A.H.
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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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“(Dr. Korchek) was straight to the point in everything. You can tell he was experienced. He said…you have a torn labrum in the right shoulder. The surgery went well. The pain wasn't bad.. the team was friendly and fun. I was in and out in no time. ”- Jason B.