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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“Got an appointment the very next day after breaking my leg. Thank the doctor at Burbank Urgent Care for calling over the referral. Everyone was very professional and compassionate. The PA and his assistant, Brian, were great at casting my leg with safety and comfort. What a relief! ”- Sai-Ling M.
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“Dr. Korchek is amazing. I can’t say enough about him. He was informative and honest and put me at ease explaining everything, ”- M.C
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“My hip replacement surgery was done by Dr. Shahan Yacoubian on 6/18/24. In the 6 week-post surgery, the improvement in my quality of life has been nothing short of transformative…A week prior to surgery, I attended a Zoom meeting given by Providence St. Joseph Hospital in which they explained what to expect and how to prepare for the procedure. Physical ... ”- Sonia M.
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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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“I interviewed several doctors for me spinal fusion. I actually have had three done on my neck but was not happy with my doctor and his love for the patient. Dr. Falkenstein is a great doctor and actually spends time with you to explain what is wrong and how he can fix it. He sits down with you shows you your MRI and shows you at the cases where people ... ”- Kowser O.
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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.