Downloads

Our forms

New patients will be required to fill out the following paperwork. We will also mail you these after you call to make your first appointment. Please remember to complete and bring to your first appointment.

• Demographics — Basic information about you, such as name, address, telephone number and other data we need to set up your record.
• Records Release — Allows us to get medical history (like reports, test results, and labs) from your other doctors.
•  Consent to use or disclose medical information — How we will use your medical information — for treatment, payment, and health care operations.

Privacy protection

We care about your privacy. For you conveinence, we’ve provided these tools for you in cases where a new account was opened in your name. If someone made unauthorized charges to an existing account, contact us and we’ll help to resolve the issue.

• Identity theft affidavit — Use this form to report unauthorized use for you personal information or account.
• Fighting Back Against ID Theft — Informational booklet to help you remedy the effects of an identity theft, provided by the FTC.