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Glendale
(818) 827–3898
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Request a call back to schedule an appointment
Please fill out the form below. We will call you as soon as we can.
I am a
New patient
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Name
Phone
Birthdate
MM/DD/YYYY
Email
What condition are you coming to see Dr. Badr for?
Do you have an MRI or CT Scan?
Yes
No
Is the scan less than one year old?
Yes
No
Do you have the CD for the scan?
Yes
No
What type of insurance do you have?
HMO
PPO
Who is your medical group?
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