NEW PATIENT FORMS

Please print and fill out the following forms to be brought with you on your first visit. In addition to these, please bring your insurance cards, a photo identification card, such as a driver’s license, and any referrals, or authorizations that are required by your insurance company.

Medical HistoryDOWNLOAD
Office PolicyDOWNLOAD
Authorization to Release PHIDOWNLOAD
Financial Agreement DOWNLOAD
Phamily Authorization DOWNLOAD
Patient Communication Consent to Contact FormDOWNLOAD
Notice of Privacy PracticeDOWNLOAD

SLIDING FEE SCALE DISCOUNT PROGRAM

Notice to PatientsDOWNLOAD
Sliding Fee Scale Discount ProgramDOWNLOAD

This Practice does not sell, rent, or lease its customer lists to third parties. This Practice may share data with trusted partners to help us perform statistical analysis, send you email or postal mail, provide customer support, or arrange for deliveries. All such third parties are prohibited from using your personal information except to provide these services, and they are required to maintain the confidentiality of your information.