patient forms

For Patients

Patient Forms

We provide all of our new patient forms online so you can complete them in the convenience of your own home.

New Office Patients:


Procedures Instructions:

Outpatient Surgical Center Information/Registration

Procedures at Los Robles Hospital:


1. If you do not have AdobeReader® installed on your computer, click the Adobe® image to download it for free.
2. Click on the necessary form, print it out and fill in the required information.
3. Please bring your printed and completed forms with you to your appointment and save time on your visit!

Adobe Reader

Insurance Information

We participate in a number of insurance plans, including:

AETNA Blue Cross Anthem
Blue Cross State Blue Shield
Coventry / First Health Cigna / Great West Health Plan
Humana Interplan
TRICARE Medicare
Multiplan / PHCS / Beech Street United Health Care / PacifiCare

Please call office to verify your insurance coverage with our office, if not cash options are available.

227 West Janss Road, Suite 315
Thousand Oaks, CA 91360

Office Hours: Mon-Thu: 9am-5pm, Fri: 9am-3pm
Phone: (805) 449-4278
Fax: (805) 449-4277