Caring for Face Pain and Sleep Apnea
Rich Hirschinger, DDS, MBA
Diplomate American Board of Orofacial Pain
9615 Brighton Way, Suite 323
Beverly Hills, CA 90210
888.981.8981
Appointment Request New Patient Forms Map and Directions

Secure New Patient Registration Forms

We are pleased to enable you to complete the new patient forms securely online. You will notice that the new patient forms are very comprehensive. This is because most patients have seen multiple doctors before they have seen Dr. Hirschinger, at his office in Beverly Hills, so he needs to know everything that has been previously tried including past and current medications, past and current treatments, etc. Also, because most patients with chronic head and neck pain have been suffering for months or years with their pain including migraine headaches, jaw muscle pain, TMJ pain, nerve pain including burning mouth syndrome, etc., he needs as much information as possible to help you, and you likely have not been asked many of these questions before. Dr. Hirschinger's goal is to get a proper diagnosis in order to provide you with the best treatment, which is why he needs the quantity of information asked. Therefore, please take the time to complete the forms and provide as much information as necessary so that Dr. Hirschinger can provide you with the best care possible. 

Please note: The forms do not time out but if you close the window, then you will need to start over. Dr. Hirschinger needs a list of the doctors you have seen and are currently seeing, the medications you currently take as well as those you have taken in the past including the dosages of the medications, and when you started and stopped. Therefore, please have this information available before you start completing the forms.