The First Step


Health History and Insurance Form

The first step of the process is to download and print the form listed below, fill it out and mail or fax it in to the clinic. The mailing address and fax number are at the bottom of this page. Providing us with this information will allow us to do three things:

  1. Evaluate your specific health situation to determine if you qualify for surgery
  2. Let you know what testing you will need to undergo before surgery
  3. Determine your insurance benefits and calculate your anticipated out of pocket costs for your specific insurance plan

When the form is received in the office, you will proceed to A Visit with Dr. Ellner.



History/Insurance Form


Fax or deliver the completed forms to the following location:

Fax (619) 286-7867

2878 Camino del Rio South Ste 303
San Diego, CA 92108