We look forward to providing you with excellent care.
Prior to your first visit please
print the following forms,
and bring them with you to your appointment.
There are 4 separate forms, the last of which is 2 pages,
so you should have 5 pages total when complete.
1. Acknowledgement of Notice of Privacy Practices
2. Medical Release Auth./Financial Responsibility & Insurance Assignment
3. New Patient Information
4. History & System Review (2 pages) --OR--
5. Youth History & System Review (2 pages for 12 and under)