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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“OSS professionals were the best possible expert guides to my recovery. They were compassionate and effective, and I am so grateful to have them as my health care providers. I highly recommend them especially for those who need hand and wrist physical therapy. ”- Iiona
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“A talented & sympathetic surgeon, Dr. Falkinstein takes his time with you, explaining your MRI and options in detail. When I opted to go straight to surgery because of my pain level and severity of disc displacement, he got me in within a week! ”- Nicole B.
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“Great Facility! Dr. Moses is perfection. ”- Tom M.
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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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“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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“I've seen Dr Stephan Yacoublan for several different injuries. He performed my surgery to fix a torn rotator cuff in the past and that was the quickest I've ever recovered from any surgery (and I've had many.). This time around I'm seeing him for my knee, where he's going to try a gel injection and physical therapy. I love that he doesn't jump straight ... ”- Krissie B.