New Patient Information

Please download and fill-out our New Patient Registration Form before you come in for your first appointment.


New Patient Registration Form

There are two ways you may choose to fill out the form:

1

  • Click the PDF icon above to download form
  • Open form in Adobe Acrobat
  • Type responses in form fields
  • Click “Submit” button to send form via email

2

  • Click the PDF icon above to download form
  • Open form in Adobe Acrobat, fill out form and print, or print form and fill out by hand
  • Bring in form at first appointment

HOSPITAL AFFILITATIONS

Pediatric Cardiology Medical Associates of Southern California are pleased to offer services at the following hospital locations.

Children’s Hospital Los Angeles
Antelope Valley Hospital
Community Memorial Hospital in Ventura
Henry Mayo Newhall Memorial Medical Center
Los Robles Hospital
Northridge Hospital
Providence Holy Cross Medical Center in Mission Hills
Providence St. Joseph’s in Burbank

Providence Tarzana Medical Center
Simi Valley Hospital
St. John’s Hospital Oxnard
St. John’s Hospital Pleasant Valley
UCLA Mattel Children’s Hospital
Valley Presbyterian Hospital
Ventura County Medical Center
West Hills Hospital and Medical Center