(323) 297-0700
info@ passporthealthla.com

Medical Director:
Dawn Terashita, M.D.

Executive Director: Rayann Aziz, P.T.

5455 Wilshire Blvd., Suite 1802
Los Angeles, California 90036

USC Executive Health & Imaging Ctr.
333 South Hope St., Suite C-145
Los Angeles, California 90071

San Fernando Valley
16550 Ventura Blvd., Suite 315
Encino, California 91436

South Bay
Del Amo Medical Ctr.
21350 Hawthorne Bl.
Suite 268
Torrance, CA 90503

 

 

 

 

 
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PATIENT FORMS
 
  

To save time, we recommend that you fill out our Patient Travel Health Information Form and bring it with you at the time of your appointment.  Even better, fax it to us ahead of time at
(323) 549-9423.

Appointments are required at all of our three convenient Los Angeles locations.

Passport Health Appointment & Cancellation Policy

Please click on Passport Health form below to obtain a printable file of
the two page form.  This form requires Adobe Acrobat Reader.  If you do not have it, you may obtain it without charge using  the Adobe Link below.

Patient Form

If you have any questions about this form or any matter relating to travel health, please do not hesitate to contact us by using the email link below or by calling our offices at (323) 297-0700.

E-mail:  info@ passporthealthla.com

THANK YOU!