• 17075 Devonshire St., Suite 205 Northridge, CA 91325

  • 16260 Ventura Blvd., Suite 600 Encino, CA 91436

  • 555 Marin St., Suite 110 Thousand Oaks, CA 91360

  • Mon - Fri : 9.00 AM - 5.00 PM

(844) 428-5864

First visit preparation at PulmoCrit Associates

Your First Visit

Preparing for Your Appointment

To make your first visit as efficient and productive as possible, please review the checklist below before you arrive. Having these items ready allows your physician to spend more time understanding your health and less time tracking down records. If you have any questions in advance, call us at (844) 428-5864 — we're happy to help.

Step 1 — Complete Your Patient Forms Before You Arrive

Please download and complete the forms below before your appointment. Completing them in advance saves significant time at check-in and gives your physician a chance to review your history before walking into the room. Bring the completed forms with you, or have them ready to hand to our front desk staff.

All forms are available in English and Español.

New Patient Forms

Download, print, and complete all forms before your first visit. Bring the completed originals with you.

All English Forms — One PDF
8 forms • Print & complete before your visit
Download All (English)
Todos los Formularios en Español — Un PDF
8 formularios • Imprima y complete antes de su visita
Descargar Todo (Español)
Or download individual forms

Patient Information / Información del Paciente

Basic demographics, contact information, emergency contact, and pharmacy details.

English Español

Consent to Treat / Consentimiento para el Tratamiento

Authorization for medical treatment, insurance assignment, and release of information.

English Español

Sleep Assessment Questionnaire / Cuestionario de Sueño

Required for sleep medicine visits. Includes the Epworth Sleepiness Scale.

English Español

Smoking History / Historial de Tabaquismo

Smoking status, employer information, and fee schedule acknowledgment.

English Español

Medical Records Release (to PulmoCrit) / Solicitud de Registros

Authorizes your previous providers to send records to PulmoCrit Associates.

English Español

Consent to Release Records (from PulmoCrit) / Consentimiento de Envío

Authorizes PulmoCrit to forward your records to your other treating physicians.

English Español

Audio & Video Recording Policy / Política de Grabación

Acknowledgment that recording is not permitted in the office per California law.

English Español

HIPAA Notice of Privacy Practices / Aviso de Privacidad

Your rights regarding how your medical information may be used and disclosed.

English Español

Current Medications

  • Bring a complete, up-to-date list of all medications you are currently taking — including the drug name, dose, and how often you take it.
  • Inhalers are especially important. Please bring the actual inhalers if possible, or note the exact name and strength (e.g., albuterol 90 mcg, Advair 250/50). Many patients use these only occasionally and forget to mention them.
  • Include over-the-counter medications, vitamins, and supplements — these can interact with pulmonary conditions and treatments.
Tip: A photo of your medication bottles is a quick and easy way to make sure you don't miss anything.

Medication Allergies

  • Provide a list of any known medication allergies or adverse reactions, including the medication name and what reaction you had (e.g., rash, difficulty breathing, nausea).
  • Include allergies to contrast dyes, latex, or anesthesia if applicable — these are relevant for procedures we may recommend.
Tip: If you're unsure of the exact medication name, bring notes about the reaction and when it occurred. That's still very useful information.

Prior Medical History

  • Be prepared to share your relevant past medical history — including chronic conditions (asthma, COPD, heart disease, diabetes, sleep apnea, etc.).
  • List any prior hospitalizations or surgeries, especially those involving the lungs, heart, or airways.
  • If you have records or notes from previous pulmonologists, cardiologists, or other relevant specialists, bring those along or have them faxed to us at (818) 360-3533 before your visit.
  • Family history of lung disease, pulmonary fibrosis, or alpha-1 antitrypsin deficiency is also helpful to share.

Chest Imaging (CT Scans & X-Rays)

  • If you have had a CT scan of the chest or chest X-ray, please bring the images or make them available before your appointment. These are often critical to your evaluation.
  • Online access: If your imaging was performed at RadNet, Renaissance Imaging, or UMI (United Medical Imaging), we can access your images directly via the internet — no CD needed. Just let us know when you schedule.
  • For imaging from other facilities, please request a CD or digital copy in advance, or ask the imaging center to send the images directly to us.
  • Bring the written radiology report as well, if you have it — your physician will want to review both the images and the report.

Health Insurance & ID

  • Bring your current insurance card(s). If you have both primary and secondary insurance, bring both.
  • Bring a photo ID (driver's license, state ID, or passport).
  • If your insurance requires a copay, be prepared to pay it at the time of your visit. We accept most major payment methods.
Not sure what your plan covers? Our staff verifies your insurance before your appointment. You can also call us or check with your insurance carrier in advance. See our insurance page for the plans we accept.

Authorization & Referral (If Required)

  • Most PPO plans, Medicare, and many direct plans do not require a referral or prior authorization to see a specialist — you can contact us directly.
  • If your plan is an HMO or IPA plan, you may need a referral from your primary care physician and/or a prior authorization number before your visit is covered.
  • If an authorization is required, bring the authorization number and letter to your appointment, or have your PCP's office fax it to us ahead of time.
  • Our team confirms coverage when you schedule — if authorization is needed, we'll let you know exactly what steps to take so there are no surprises at your visit.
Not sure if you need a referral? Call the member services number on the back of your insurance card, or just call us at (844) 428-5864 and we'll help you figure it out.

Day of Your Appointment

  • Arrive 15 minutes early to allow time for check-in and any remaining paperwork.
  • New patient consultations typically take 45–60 minutes. Please plan accordingly.
  • Wear comfortable, loose-fitting clothing — you may have breathing tests performed at your visit (such as spirometry or a pulmonary function test).
  • Do not smoke for at least 4 hours before breathing tests, as this affects results.
  • If you use a rescue inhaler (like albuterol), try to avoid using it for 4–6 hours before the appointment unless medically necessary — it can affect spirometry readings.
  • Bring a list of questions you'd like to ask your physician — there's no such thing as too many questions.

If You've Been Scheduled for a Home Sleep Study

Home sleep studies performed at our office require a smartphone. Before your device pickup appointment, you will need to:

  • Have a smartphone available — the sleep study device communicates through a dedicated app on your phone.
  • Download the required app before your pickup appointment. Our staff will provide you with the app name and setup instructions when your appointment is scheduled.

Questions? Call us at (844) 428-5864 and we'll walk you through the setup.

First Visit Quick Checklist

Here's a condensed version to print or save on your phone:

  • Patient intake forms completed in advance
  • Photo ID
  • Insurance card(s)
  • Authorization & referral (if required by your plan)
  • Complete medication list (especially inhalers)
  • Medication allergy list
  • Prior medical history summary
  • Chest CT or X-ray images & reports
  • Records from prior relevant specialists
  • Arrive 15 minutes early

Have questions before your appointment? We're happy to help.

Request an Appointment Contact Us New Patient Info

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