To Dr. Huddleston

The Hip and Knee Institute

Please print out this form to mail or fax to Dr. Huddleston.

FAX to Dr. Huddleston at 818.708.3901

or MAIL to Dr. Huddleston at
The Hip and Knee Institute
5525 Etiwanda Ave., #324
Tarzana, CA 91356

Tel: 818.708.9090
I would like to arrange a telephone consultation with Dr. Huddleston.

Name: _________________________________________________

Address: _______________________________________________

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Telephone: Home: ____________________________________

Work Number:________________________________________

Fax Number: _________________________________________

The best time to reach me on the telephone is between ________ and _______ California time.

Please check off:

  1. I have a hip / knee / shoulder problem.

  2. I will / will not be mailing x-rays for review.

  3. I have previously had joint surgery.

  4. I have a medico-legal problem.

Other comments: _________________________________________

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