Patient Forms

Please download, print and complete the appropriate PlatinumCare LA forms before your appointment, then bring them when you come in. This will save time during your visit. If you have any questions about which to fill out or how to complete any paperwork, please call the office and we’ll be happy to assist you.

If you are a new patient, please also complete our new patient form here.

Along with the forms, please also remember to bring a photo ID and a copy of your current insurance to your appointment.

New Patient Forms

Patient Information

Informacion de Paciente

Authorization for Release of Records

Other PlatinumCare LA Forms

If you are a blood pressure maintenance patient, or have been advised to keep a log of your blood sugar and/or blood pressure, you may download, print and use these forms to begin these records. These worksheets are also available in our office.  For some patients, keeping a running log of blood pressure and blood sugar measurements can help physicians in the quality and accuracy of their treatment and highlight any significant patterns.

Blood Sugar Log

Blood Pressure Log