New Patient Forms

During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor.  We accept most insurances.

Patient Forms
Please print and fill out the New Patient forms so we can expedite your first visit.

pdf podiatry patient form downloadNew Patient Form

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

  • Patient's insurance card
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient's medical and surgical history
  • Recent test results, x-rays, or relevant records

Insurance and Payment Information

You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please call our office (949) 365-1700. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Dr. Birjandi is a participating provider of most insurance companies.  Some examples are ( not a complete list):  Blue Sheild of California, Blue Cross Anthum, Aetna, United health care, Cigna, Medicare-Medical, Medicare-Private, Tricare, CHOC ( needs a first time primary care referal).  Dr. Birjandi is not a provider of HMO’s insurances.  To be certain if Dr. Birjandi is a provider of your insurance company, either yourself or our office can make that confirmation by calling the insurance company.  Benifits and coverage are determined by staff before your visit. All disclosures are made prior to services being rendered.  In cases where treatment modalities are not covered by your insurance company, you will be given an explanation and a financial agreement for such services.  Examples are:  Laser treatment of toenail fungus which is considered aesthetic and is not covered by insurance companies.  All major credit cards are accepted and Care Credit financing is available for laser treatment and other services not covered by insurance companies.

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