New Patients

Welcome — We're Glad You're Here

Your first visit to LA Hearing Diagnostics involves a few simple steps so we can get to know you. Read what to expect below, then save time by completing your registration online before your appointment.

Our Mission

Uncompromising excellence in hearing care

Our practice is working together to realize a shared vision of uncompromising excellence in hearing healthcare. To fulfill this mission, we are committed to:

  • Listening to those we are privileged to serve.
  • Earning the trust and respect of patients, profession, and community.
  • Exceeding your expectations.
  • Ensuring a caring and compassionate professional environment.
  • Striving for continuous improvement at all levels.

What to Expect

Your first visit

Being well-prepared for your appointment ensures the doctor has all the information needed to provide the best possible care for you. It also helps relieve any unnecessary anxiety you may be feeling. Take some time to review our services and get familiar with our doctors — we look forward to your first visit.

  • Plan for 60–90 minutes for your first appointment.
  • Bring your insurance card and a photo ID.
  • Bring a list of current medications, and a loved one whose voice you know well if you'd like.
  • Complete the registration form below to save time at check-in.
2220 Lynn Rd, Suite 202, Thousand Oaks, CA
Mon–Fri · 9am–5pm
888-966-3277

Patient Registration

Complete your registration online

No printing, no clipboard. Fill this out in a few minutes and we'll have everything ready when you arrive.

Patient Information

Primary Insurance Information

If you'd like us to verify your benefits before your visit, complete this section. You can also simply bring your insurance card to your appointment.

Agreements & Signature

Assignment and Release

I, the undersigned, certify that I (or my dependent) have insurance coverage with the carrier listed above, and assign directly to LA Hearing Diagnostics and its providers all insurance benefits, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I hereby authorize the doctor to release all information necessary to secure the payment of benefits. I authorize the use of this signature on all insurance submissions.

Patient Financial Policy

Thank you for choosing LA Hearing Diagnostics for your hearing healthcare. Our goal is to provide you with the highest quality care possible. We find that communication with our patients regarding our financial policy assists us in providing the best service to you. We must emphasize that your health is our primary concern, regardless of your insurance. The following is a statement of our financial policy, which we request that you read and agree to prior to treatment. To avoid any misunderstandings, please contact us should you have any questions about our policies.

Your insurance policy is a contract between you and your insurance carrier. As a result, it is your responsibility to know your insurance plan requirements, to determine whether or not you have out-of-network benefits (if we are not a participating provider for your insurance plan), and to make sure that our office has all current demographic and insurance information at each visit. Please bring your insurance card with you at the time of your appointment. As a courtesy, upon verification of coverage, we will file your insurance claim for you. If we are unable to verify your coverage or you are unable to provide us with your insurance information, full payment is due at the time of service. If you are not covered by insurance, or if your visit or services are not covered by your plan, you are responsible for payment in full at the time services are rendered.

Insurance co-pays are due at the time of service and before you see the doctor. If you are unable to pay your co-pay, you may be asked to reschedule your appointment. Because our providers are specialists, higher co-pays may apply (consult your policy benefits for clarification). You are also responsible for any co-insurance, deductibles, and/or non-covered services. If you are unsure whether a service is covered by your plan, please contact your insurance carrier to determine what your benefits will allow. Additionally, advance payment may be required for certain major procedures and some in-office services. We accept payment in the form of cash, check, or major credit card. There will be a $25 fee for all returned checks.

Once insurance has processed the claim, patients will receive monthly statements asking to clear the balance of their account. If payment arrangements are necessary, it is your responsibility to contact our office to establish a reasonable plan. If you feel an error appears on the statement, or if you have any questions or concerns, please contact our office.

As a courtesy, we attempt to contact every patient to remind them of their appointment time; however, it is the responsibility of the patient to arrive for their appointment on time. We understand that sometimes you may be running late. Unfortunately, we have patients scheduled throughout the day and may not be able to see you if you arrive more than 15 minutes after your scheduled appointment time. We will try to accommodate you if time allows; otherwise, we will need to reschedule to another date and time. We ask that you notify us at least 24 hours in advance if you need to cancel or reschedule your appointment. We reserve the right to charge for missed appointments.

In short: if your visit or a service is not covered by your insurance, you are responsible for payment.

By typing your name above, you agree it serves as your electronic signature for the Assignment and Release and the Patient Financial Policy.

Your information is sent securely to our front office and used only for your care and billing.

Haven't scheduled your first visit yet?

We'll find a time that works for you at our Thousand Oaks clinic.