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Lumbar Spinal Condition | Neurology | Los Angeles Spine MD Staff | Los Angeles Dr Todd H Lanman MD | Neurologist | Los Angeles Spinal Surgery | Los Angeles Dr. Todd H. Lanman, M.D. | 450 North Roxbury Drive | Third Floor | Beverly Hills, CA 90210 | Tel: 310-385-7766 Contact Spine MD | Spinal Surgeon | Los Angeles
Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.

Patient Information
Oswestry Disability Questionnaire
Neck Disability Index
Quadruple Visual Analogue Scale
Authorization, Assignment of Benefits
Instructions For Communicating Personal Health Information
Out of Network Benefits
HIPAA Information

Other Helpful Forms and Links

DMV Disability Form    

» Click here for more information on California State Disability Insurance (SDI).


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If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.

 

 

 
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Dr. Todd H Lanman M.D., is an experienced neurosurgeon offering lower back treatment, lumbar surgery, and other services to Los Angeles and the surrounding area.

Dr. Todd H. Lanman, M.D. | 450 North Roxbury Drive | Third Floor | Beverly Hills, CA 90210 | 310-385-7766
Dr. Todd H. Lanman MD | 1360 W. 6th Street | East Building, Ste. J | San Pedro, CA 90732 | 310-833-3357 | www.spine.md

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