Dr. Cherik's Office

What to Bring to the Appointment
Patient Forms
Insurance and Payment Information
Hospital Affiliations
Notice of Privacy Practices

What to Bring to the Appointment

• Patient's insurance card
• Physician referral forms, if required by insurance
• List of prescriptions and/or over-the-counter medications, including dose and frequency
• Information about the patient's medical and surgical history
• Recent x-rays or relevant records

Patient Forms

You can download and print patient forms before your appointment using the links below.

• Patient Registration Form - (Under construction)
• Physician-Patient Arbitration Agreement

Insurance and Payment Information

Dr. Cherik is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for charges that are not covered by your insurance, at the time of your appointment.

Your insurance company may require a co-payment at the time of your appointment. When necessary, our staff will work with patients to set up a payment plan.

If you have questions regarding billing or which insurance plans we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Hospital Affiliations

• Glendale Memorial Hospital
• Glendale Adventist
• Verdugo Hills

Notice of Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.