Ziering Medical

Health History

Form

  • MM slash DD slash YYYY
  • Answer all questions by selecting YES or NO

  • MM slash DD slash YYYY
  • Do you have or have you ever had:

  • MM slash DD slash YYYY
  • For women only:

  • Photo Upload

    Please provide photos following the style and instruction on this guide HERE

  • Max. file size: 32 MB.
  • Max. file size: 32 MB.
  • Max. file size: 32 MB.
  • Max. file size: 32 MB.
  • Max. file size: 32 MB.
  • Max. file size: 32 MB.

COVID-19 Practice POLICY UPDATE

Ziering Medical would like to express our support and best wishes to all of you during this difficult time.

Ziering Medical has suspended our full menu of services to abide by the state action that all nonessential businesses in California must close. But while our office is closed for in-person consultations and procedures, we are still offering virtual consultations. 

If you would like to schedule your virtual consultation please do so by clicking the button below and filling out a request form.