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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“I went to Dr. Mikhael for (an) ankle ligament and bone spur surgery. The entire process was smooth and easy as surgery can be. I also went to their physical therapy center for recovery. Everything there from Apryl to their PT assistants were ready and helpful. ”- Brian
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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. Moses was Fantastic He diagnosed my hand problem and gave me all the information I needed to know about having a Trigger Finger. I've never had an appointment go so well. Kudos to the entire staff. ”- P.C.
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“Great Facility! Dr. Moses is perfection. ”- Tom M.
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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.