KIETH J. BURKART, O.D., A PROFESSIONAL CORPORATION
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Patient Forms

Patient Registration Form
File Size: 550 kb
File Type: pdf
Download File

HIPAA Privacy Notices
File Size: 1279 kb
File Type: pdf
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Under the Privacy Act, our office privacy practices
Acknowledgement of Privacy Practice
File Size: 285 kb
File Type: pdf
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This form, once signed acknowledges that you have read and understood our office privacy practices.
Medical Records Release
File Size: 690 kb
File Type: pdf
Download File

Contact Us
29099 Hospital Rd., Ste. 205
P O Box 2226
Lake Arrowhead, CA 92352
Phone: 909-337-4310
EMAIL officestaff@kiethjburkartod.com

Office Hours
Mon    9:00 am - 5:00 pm                          
Tue     9:00 am - 5:00 pm
Wed    9:00 am - 5:00 pm
Thu     9:00 am - 5:00 pm
Fri       9:00 am - 12:30 pm Only
*Lunch 12:30-2

Notice of Privacy Practices

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  • Home
  • Our Practice
  • Our Services
  • Patient Forms
  • Location
  • PATIENT PORTAL