OFFICE
LOCATION
11190 Warner Avenue
Suite 310
Fountain Valley, CA 92708
Phone (714) 979-2401
Fax (714) 966-0837
APPOINTMENTS
AND WAITING TIME
Please call the office to make an appointment in advance. We will do our best to
accommodate you in a timely manner. True emergencies are always given priority. New
patient appointments typically last at least 45 minutes, please bring a book or other work
to do to help pass the time. We make every attempt to adhere to our appointment
schedule while trying to accommodate our established patients as well as our new
patients. If you are unable to keep your appointment, please call us as soon as possible so
that we may reschedule your appointment. Below is our weekly schedule:
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
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8:30am
- 12pm |
SURGERY |
Office
hours in
Fountain Valley |
SURGERY |
SURGERY |
SURGERY |
|
2
pm 5 pm |
SURGERY |
Office
hours in
Fountain Valley |
Office
hours in Fountain Valley |
SURGERY |
Office
hours
in Fountain Valley |
|
*There
are times when Dr. Mudiyam must perform emergency surgeries or attend
to urgent hospital matters on patient days and we appreciate your
understanding if we run late. |
If
you cannot access the forms you can click on the icon to download
the software.

|
NEW
PATIENT PAPERWORK
As directed by our office please download the forms
and bring them completed to your scheduled office visit. This will help
expedite the registration process. Thank you.
PATIENT INFORMATION SHEET
PATIENT MEDICAL
HISTORY FORM
PATIENT
PAIN DRAWING
PATIENT CONSENT FORM
NOTICE OF PRIVACY PRACTICES
FINANCIAL POLICY
If you have neck pain please fill out the following questionnaire:
NECK DISABILITY QUESTIONNAIRE
If you have low back pain or leg pain please fill out the following questionnaire:
OSWESTRY DISABILITY QUESTIONNAIRE
PAYMENTS
AND INSURANCE PLANS
We request payment arrangements for all office services at the time they
are rendered unless prior arrangements have been made. We accept Medicare
and most PPO plans. We are not a part of any HMO plans and do not accept
third party insurance. If we are a participating provider of your insurance
company, we will bill them. However, payment is the patients responsibility.
We will help in any way we can to assist you in handling claims. We accept
cash, checks, debit cards and major credit cards.
PRESCRIPTIONS AND REFILLS
Please request all prescriptions and refills through your pharmacy between
8am-4pm Monday through Friday. We do NOT refill prescriptions on weekends.
After you contact your local pharmacy with your request, they will call
us with the correct medication name and dosage to ensure your prescription
is accurate. We recommend you request your refills at least one day before
you run out of medication so that you will never be without them.
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