ELYSE RUBENSTEIN, M.D., F.A.C.R.

A PROFESSIONAL CORPORATION


Committed to the Diagnosis and Treatment of Arthritis

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Forms

New patient forms:

    • New Patient Packet

Individual forms:

    • New Patient Intake Form
    • Authorization to Release Information Form
    • Patient Consent Form
    • Release of Medical Records Authorization Form
    • Confidentiality of Patient Medical Records

Address :
1328 16th Street
Santa Monica, CA 90404

Appointments and Information:
Phone: (310) 256-2425
FAX: (310) 395-3218

Phone Hours:
Monday – Friday, 9am – 5pm

Copyright © 2016 ELYSE RUBENSTEIN, M.D. CORP. All rights reserved. Terms and Conditions