Information Forms
Below are two forms required to be filled out at our office and can be printed at home. Filling out these forms ahead of time will save you time during your visit. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit. Please be prepared to provide this information to our office along with your current medical insurance information, a list of your current medications and payment for any co-pays or deductibles. Cash or check is the only form of payment we receive.
Download application PDFs here:
Medical History Form (English)
Medical History Form (Spanish)
The following is a list of networks we are currently contracted with:
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** We reevaluate participation in various insurance plans from time to time. If your plan is not listed or you have questions concerning the above information, please contact our office at (760)355-8500.
Full-time Imperial Valley Practice – Experience Since 1982
Treating Patients of All Ages
Mohammad K. Arab, MD, FACS
516 West Aten Road, Suite 4, Imperial, CA 92251
(Just West of La Brucherie)
Business Hours:
Monday – Friday
9:00 a.m. to 5:00 p.m.
Business: (760)355-8500
Fax: (760)355-8558
In Private Practice Since 1982
Board Certified, American Board of
Otorhinolarynology Fellow, American Academy of Facial Plastic and Reconstructive Surgery.
