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Please print out a POTENTIAL PATIENT FORM , complete it, and fax it back to our office at 714-565-1035 along with all recent and pertinent laboratory or x-ray reports. Included with this form is information about our office that you should review before submitting it. Please send a copy of your Records Release Request to your doctors AND call their office to expedite getting your medical records forwarded to our office. We will also need a copy of the Records Release Request in case you need help in getting the records to our office. Dr. Kaslow will review your information and prioritize your consultation. We may request that you complete additional information or forms before we agree to participate in your care. You may want to look at our office policies first.
Please recognize that our practice is not meant to be all things to all people and that choosing each other is a mutual decision. From the profile you send us, we may determine that you are not a good candidate for our approach to health care. On the other hand, if we are a good match for each other, when the office has set up your appointment, please expedite getting all intake forms and medical records to us as soon possible.
We are not in-network for Blue Cross, Blue Shield, HealthNet, United Health Care, Aetna, Pacificare, One Health Plan, Mega Health, Private Health Care Systems (PHCS), Choice Care, Medicare, or MediCal. This basically means that your insurance company will be billed as a courtesy to you, but you are responsible for the entire amount of your bill. Most insurance companies cover a portion of your care depending on the plan. We want this to be clear in the beginning so it does not interfere with the healing relationship.
Thank you for your interest.
Jeremy E. Kaslow, M.D., F.A.C.P., F.A.C.A.A.I.
Susan Kaefer, R.P.T.
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