Patient Forms

ear infections surgeryPlease print and fill out the patient information form. Bring the completed form with you to your scheduled appointment. You may also fax the form to the office at 619-265-1114. In addition to the completed form, please bring all insurance cards and copayment. We accept cash, checks and most credit cards.  If you have any questions while completing the form, feel free to call us at 619-583-8990.

ยป Patient Forms

Theodore M. Mazer M.D.

6699 Alvarado RD. Suite 2209
San Diego, CA 92120

Phone: 619-583-8990
Fax: 619-265-1114

Mon-Fri 9:00 am - 5:00 pm