BECOME OUR PATIENT YOUR EAR SURGERYHaving ear surgery and finding the right surgeon to perform your procedure can be stressful. From the worries of possible discomfort, hearing damage, and recurrent issues, it is always in your best interest to get a second opinion. Remember, most ENT surgeons are generally trained and may not have the specific fellowship training for complex and advanced ear problems.At the Osborne Head and Neck Institute, Dr. Ronen Nazarian is proficient and trained to handle the most complex ear cases. He will take the time to explain your treatment options and the plan is tailored to your specific case.We understand that it is often inconvenient, time-consuming and expensive for patients to fly to our Los Angeles office for a consultation, then fly back again a few weeks later for surgery. We have designed a program to facilitate your experience that will allow you to determine the best options available to you from the comfort of your home. CONTACT US NOW FOR YOUR PHONE CONSULTATIONThe first step is to call or email our patient care consultant, and request a preliminary phone or in-office consultation with one of our specialist regarding your ear problem. SEND RECORDS / EXAMSWe accept all records via mail, fax, or e-mail. Please send any past hearing tests if you have them available. All previous X-ray, CT, or MRI scans and reports, including doctors’ notes and operative reports should be included with your information. OBTAIN AN EVALUATIONDr. Nazarian will review your history, physical exam findings and all reports, review your films, and discuss all your options with you, and together you will come up with a customized treatment plan. You will then be contacted by our Patient Care Consultant who will discuss pre-operative care, costs, recovery, local accommodations and any questions related to your procedure(s). PATIENT FORMSOur patient care coordinator will provide you with the specific forms you need to fill out before your visit. For more information, please contact our patient coordinator at (310) 657-0123. SCHEDULE YOUR PROCEDUREOnce you have decided to proceed, we will reserve your surgery date. READ, INITIAL, SIGNShortly after your surgery is scheduled, you will receive a packet in the mail containing pre-operative instructions and procedure consents. These documents must be read carefully and all instructions followed closely. All contents must be signed and initialed. The entire pre-operative packet must be brought with you to your pre-operative office visit. If you have any questions at this time, please do not hesitate to call or email the office for clarification. SURGERY DISCLOSURE POLICYAt the Osborne Head & Neck Institute, our board certified physicians perform all surgeries from start to finish. Although we conduct clinical research studies and contribute a significant amount to journals and publications, we are not a surgical-training center. This means that a board certified surgeon, performs every aspect of your evaluation and treatment from beginning to end. We do not allow residents, fellows, or other trainees to perform any portion of your surgery. EMBASSY / VISA INFORMATIONFor travel outside the U.S. please contact your perspective Bureau of Consular Affairs for assistance on obtaining a travel visa. Please allow ample time approximately 2-4 weeks prior to your procedure for paperwork to be processed by the U.S. State Department and your government consulate. Please call if you need assistance with this process or click the link here: Travel.State.gov. FLY IN FOR SURGERYOur local international airport is Los Angeles International (LAX). We are located approximately 30 minutes from LAX. You MUST arrive one to two days prior to your surgery date. At a designated time during this period you will meet with the doctor(s) and have an in-depth consultation discussing all procedures. All consents should be signed and dated for the pre operative appointment. If you have any questions, please do not hesitate to call or e-mail our office. HOTELSThese hotels are located close to our office and are the most convenient for appointments, surgery, and follow-up. We have also had positive feedback about these locations from our patients.Four Seasons | Hotel Sofitel | Beverly Terrace | Carlyle Inn | Residence Inn | Wilshire Crest Inn LODGING INFORMATIONTravel Stipend Available* *A travel stipend is provided to assist patients from out of town. Travel stipends assist out of town patients with ancillary costs directly associated with their surgery. Stipends may cover part or all of the cost of airfare, ground transportation, and/or lodging, and are available only to surgical patients. Travel stipends are gran ted by a committee on a rolling basis. Resources are limited annually and provided through the foundation. Please ask Noelia Fedi (surgical coordinator) if you would like to be considered. *Stipends provided through a generous grant by the Division of Head and Neck Surgery (OHNI), administered by the Osborne Head and Neck Cancer Foundation. RECOVERYWe advise all patients that fly-in for surgery to spend at least the first night after their procedure in a local hotel or after-care facility, thus ensuring convenience for any required medical attention. In the days that follow we will see you post-operatively and, depending upon the procedures that have been performed, you may return home within 3-7 days after arrival in Los Angeles. In the event that you require any medical attention after returning home, we will refer you to a local physician for a check-up. Your health and safety remain our number one priority. We look forward to meeting you and assisting in your care.CONTACT US Request or schedule your appointment date online by filling out the appointment scheduling request form below and you will be contacted within 48 hours to confirm your date. *indicates mandatory fields Note: Do not use this form for an emergency!NAME:* First Last DATE OF BIRTH:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920EMAIL ADDRESS:* ADDRESS:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country MOBILE PHONE NUMBER:*HOME PHONE NUMBER:*Are you a new patient?*Yes, I'm new patientNo, I'm a returning patientSelect Your Preferred Contact or Appointment Date:* Date Format: MM slash DD slash YYYY Appointment Scheduling*Please choose your preferred consultation: phone, in-office, or video consultation.Phone / VideoOffice AppointmentHOUSTON MEETINGLOS ANGELES MEETINGCHICAGO MEETINGNYC MEETINGORLANDO MEETINGEUROPE MEETINGSelect your physician:Dr. NazarianReason for your appointment:*Please use the buttons below to upload photos or documents:Accepted file types: jpg, gif, png, bmp, pdf, jpeg.Accepted file types: jpg, gif, png, bmp, pdf, jpeg.Accepted file types: jpg, gif, png, bmp, pdf, jpeg.NAME OF INSURANCE COMPANY:INSURANCE MEMBER ID NUMBER:INSURANCE CUSTOMER SERVICE PHONE NUMBER:OCCUPATION:MARITAL STATUS:SINGLEMARRIEDDIVORCEDSEPARATEDWIDOWDOMESTIC PARTNERSPOUSE NAME: First Last SPOUSE PHONE NUMBER:EMERGENCY CONTACT NAME: First Last EMERGENCY CONTACT PHONE NUMBER:EMERGENCY CONTACT RELATIONSHIP TO YOU: This iframe contains the logic required to handle Ajax powered Gravity Forms.