New Patient Forms
Dear New Patient,
Welcome to the office of Glenn Tisman, M.D., A Medical Corporation. By now, you have contacted our office and have a scheduled appointment. If you have not done so, please call us at 562-789-8822 before proceeding.
On this page, you will find links to five different forms that must be completed and submitted to our office prior to your visit. In addition, you will have to obtain important medical records from your doctors and make sure they are sent to our office.
THE FORMS:
The forms you must fill out include:
- Medical History Questionnaire (lengthy—we’re sorry—but very important)
- Authorization to Release Information (with whom you will allow us to discuss your information)
- Medical Information Release Authorization (allows other providers to release your medical records to us)
- Patient Consent Form (describes our commitment to HIPAA and your privacy rights).
- Payment Responsibility Form (describes our payment policy)
Please download and complete these forms. Make sure your writing is legible and your answers thorough.
THE MEDICAL RECORDS:
Please contact your current and past physicians and instruct them to forward all consultations, radiology (x-rays, CT scans, PET scans, ultrasounds, MRI scans), laboratory, operative and biopsy/pathology reports that are relevant to your current health status to our office.
THE DELIVERY:
We must receive all forms and all medical records no later than 10:00 AM, two business days prior to your appointment. This information allows Dr. Tisman to give your case a thorough medical analysis and gives us time to pursue any additional information he might require to understand, treat or diagnose your condition.
It is our office policy to postpone an appointment if relevant medical records and/or patient questionnaires have not been received 48 hours prior to the date of your scheduled consultation.
Materials may be mailed to us:
Glenn Tisman, M.D., A Medical Corporation
13025 Bailey Street
Whittier, CA 90601
Materials may be faxed to us:
562-698-4582
If for any reason you are not able to attend your confirmed appointment, please give us a courtesy call at least 48 hours in advance.
If you have any questions about these forms, please call our office and we will gladly assist. We look forward to meeting you!
Happiness and Health,
Melanie Tisman
Practice Manager