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

Patient Health Information Release Forms

Please note these are "fillable" forms, which means you can use your keyboard and mouse to complete the forms, and then print, and sign them, or you can print them and complete them with a pen.

Release to: Please click this link to download the form to have your doctor release your health information to Dr. Hirschinger.

Release from: Please click this link to download the form to have Dr. Hirschinger release your health information from him to you and/or your doctor.

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