Secure New Patient Registration Forms
We are pleased to enable you to complete the new patient forms securely online. You will notice that the new patient forms are very comprehensive. This is because most patients have seen multiple doctors before they have seen Dr. Hirschinger, at his office in Beverly Hills, so he needs to know everything that has been previously tried including past and current medications, past and current treatments, etc. Also, because most patients with chronic head and neck pain have been suffering for months or years with their pain including migraine headaches, jaw muscle pain, TMJ pain, nerve pain including burning mouth syndrome, etc., he needs as much information as possible to help you, and you likely have not been asked many of these questions before. Dr. Hirschinger’s goal is to get a proper diagnosis in order to provide you with the best treatment, which is why he needs the quantity of information asked. Therefore, please take the time to complete the forms and provide as much information as necessary so that Dr. Hirschinger can provide you with the best care possible.
Please be aware of the following three items:
- We do not recommend completing the forms with a mobile phone. Please use a desktop, laptop, or tablet.
- The forms do not timeout but if you close the window, then you will need to start over. Dr. Hirschinger needs a list of the doctors you have seen and are currently seeing, the medications you currently take as well as those you have taken in the past including the dosages of the medications, and when you started and stopped. Therefore, please have this information available before you start completing the forms.
- Please use the Calendar icon to open the drop-down menu to select the dates. If you prefer typing, the format must be “12.17.1989” for December 17, 1989.
Patient Health Information Release Forms
Please note these are “fillable” forms, which means you can use your keyboard and mouse to complete the forms, and then print, and sign them, or you can print them and complete them with a pen.
Release to: Please click to download the form to have your doctor release your health information to Dr. Hirschinger.
Release from: Please click to download the form to have Dr. Hirschinger release your health information from him to you and/or your doctor.