Location: 1148 Manhattan Ave Suite 9 Manhattan Beach, CA 90266      Email: suziedupee@drdupee.com


Here you will find the necessary forms

Please select the required form to download


Acknowledgement of HIPPA Agreement

HIPPA Agreement

Patient Agreement and Notification

Physician Arbitration Agreement

Welcome Sheet

Welcome Sheet for Financially Responsible Parties

For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.  https://openpaymentsdata.cms.gov