Forms & Scheduling

Patient Forms & Submitting Instructions

Where Your Surgery May Be Scheduled

Tips to Facilitate your Procedure

Appointment Request

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Disclaimer: This website is intended for general information ONLY & is not intended to render medical advice. Please contact your doctor for more informaiton.
E-mails should not be used for medical questions but just for administrative or billing questions.

Appointment Request

Please fully fill out this form and your request will be answered in a timely manner

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Where Your Surgery May Be Scheduled

The Doheny Endosurgical Center is a state of the art outpatient ambulatory surgical facility that focuses on providing the highest level of patient care in a comfortable and safe environment. Doheny Endosurgical Center is physician owned and the doctors take great pride in selecting only the highest quality technicians, nurses and medical personnel who will personalize your care and make your experience a pleasant one.

Accreditation Standards
Doheny Endosurgical Center has achieved accreditation by the nationally recognized
Accreditation Association for Ambulatory Health Care (AAAHC) as well as Medicare Certification from the Department of Health Services. Accreditation by AAAHC and other regulatory boards demonstrates that Doheny Endosurgical Center has passed a series of rigorous, extensive and nationally recognized standards for the provision of
quality health care and underscores our longstanding commitment to providing the highest possible levels of quality care to the community we serve.

Building Address & Telephone

9090 Wilshire Blvd., Suite 100, Beverly Hills, California 90211
Telephone 310.246.2555 | Facsimile 310.285.0819

The Doheny Endosurgical Center is conveniently located on the Southeast corner of Wilshire Boulevard and Doheny Drive (entrance on Doheny) in the City of Beverly Hills. Valet parking (non-validated) is available in our building. Additional parking is available at 100 South Doheny Drive at a more reasonable rate and one (1) hour metered parking is available throughout the area.

An Introduction of the Doheny Endosurgical Center




Cedars-Sinai Medical Center
8700 Beverly Boulevard.
Los Angeles, CA 90048

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Tips to Facilitate your Surgery

• Please review all instructions provided by your doctor regarding your preparation;

• Wear comfortable, casual clothing that is easy to change;

• Leave all valuables and jewelry at home;

• Please arrange to be accompanied home by a responsible party after your procedure; (Taxi cabs or public transportation are not permissible unless properly accompanied)

• Please provide a complete list of your allergies and all current medications upon check in;

• Please contact your doctor if you are having any signs of illness before your scheduled procedure/surgery;

• Please provide your insurance card to the staff upon your arrival.

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Click on a thumbnail to view & print the forms below.
Fax your completed form to (310-285-0482)

Contact: Cecelia Medina with any questions

Links to new 2014 Forms please click the underlined links that best suit your needs all are in PDF format:

UPDATED 10/3/2016

Patient Registration Forms & Healthcare Questionnaire (Updated 10/3/2016)

Doheny Endosurgical Packet

Movi-Prep Instructions (Full Packet)

Privacy Policy and Consent of Payment

SB Capsule Endoscopy


Medical Release Authorization

Patient Information forms *UPDATED MARCH 2016*
Colonoscopy w/Movi-Prep Preparation
Instructions for Flexible Sigmoidoscopy
Colonoscopy w/ Golytely Preparation

Patient Instructions for Pill Camera
Patient Intructions Upper Endoscopy
IERCPPatient Instructions


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