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FORMSmovementhelp2019-10-29T12:12:35-07:00

New Patient Intake Form

To help you save time during your first visit, we have our New Patient Intake Form available for download. You can fill it out before you arrive.

DOWNLOAD FORM

NCNI Corp.

As the premier movement disorder related facility, we’re committed to providing you the medical care you deserve.

Dr. Farzin B. Pedouim

Contact Info

(844) NeuroDr
(844) 638-7637
NeuroHelp@NCNICorp.com

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Locations

2080 Century Park East, Suit #1403
Los Angeles, CA 90067

18377 Beach Blvd,
Suite #330
Huntington Beach, CA 92648

Send Email for an Appointment

Please complete the form below and we will contact you to book your appointment.

I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.