Why sit in the office filling out forms?

Download the appropriate forms and complete them at your convenience.

You will need Adobe^® Acrobat reader to view and print out the forms. If you do not have a reader, you can obtain a free copy through this link.

   New Patients Will Need To Complete These Forms

• Registration Form (17K pdf file, 2 pages)
• Financial Policy (81K pdf file, 1 page)
• Medical History Form (21K pdf file, 1 pages)
• Acknowledgment of Receipt of Notice of Privacy Practices (11K pdf file, 1 page)
• Please note that the Acknowledgment of Receipt of Notice of Privacy Practices Form states that you have received and read the Notice of Privacy Practices (24K pdf file, 2 pages).  Please download and read before completing the form.

   Optional Forms/Information Pages

• Authorization to Release Healthcare Information (14K pdf file, 1 page)
• If you would like to have your medical records released, you are welcome to come by the office and fill out the form or you can either fax or mail it in.  If you fax or mail your request, you must include a copy of your drivers license or a photo ID for identity verification.
  Please allow AT LEAST one week to process your request....

NOTE: If you would like to have your medical records from a previous provider released to us, you are welcome to come by the office and fill out the necessary form.

Updated: 7/21/09