Patient Information
Hospital Affiliation:
Providence Saint Joseph Medical Center, Burbank CA 91505
Your First Appointment:
Please arrive 10-15 minutes 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
Patient Forms:
Use the following links to download forms that may be necessary for your appointment. Please call if you need clarification about which forms are needed. For the ones you need to fill out, please print a copy and complete the form. Please bring all completed forms to your appointment.
Health History Form [PDF]
Insurance and Payment Information:
Tuli Eye Care Center is a provider for Medicare and most major insurance plans, and provides insurance billing. 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 contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.
Privacy Practices: