TO OUR PATIENTS:
This Notice has been prepared to inform you that the ORTHOPAEDIC MEDICAL GROUP and ATHLETIC REHABILITATION CENTER, INC. is a California Corporation and that the ATHLETIC REHABILITATION CENTER and the physical therapy facilities associated with it are integral parts of said corporation.
The doctors further wish to inform you that one or more of the above named orthopaedic surgeons have a significant beneficial interest in the following health care facilities:
- SAN GABRIEL VALLEY SURGICAL CENTER
- FOUR SEASONS SURGERY CENTERS
- ATHLETIC REHABILITATION CENTER
- CASA COLINA SURGERY CENTER
We feel that competent and qualified medical services or procedures are provided by these facilities. However, you have the absolute right to use any alternative facility of your choice. You are not obligated to use any facility recommended by your physician. Your physician will be happy to recommend and discuss other facilities which provide the same medical services or procedures.
I CERTIFY THAT I HAVE READ AND UNDERSTAND THE ABOVE STATEMENT AND ANY QUESTIONS I HAVE CONCERNING THE ABOVE MATTER HAVE BEEN ANSWERED.
DATED: ____________________________
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PATIENT SIGNATURE
Orthopaedic Medical Group and Athletic Rehabilitation Center, Inc.
1050 Lakes Drive
Suite 100
West Covina, CA 91790
Tel: 626.918.6655
Fax: 626.918.6633
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