For your convenience, you can print and fill out the below forms at your home or office prior to your appointment. Just bring them with you on the day of your first visit.
If you do not already have AdobeReader® installed on your computer, click here to download.
1) New Patient Application for Care:
This lets us know the history and current state of your health. Please fill it out as best as you can. The more we know about your health problem, the better we’ll know if we can help you.
2) Terms of Acceptance and Protecting Your Health Information Forms:
The ‘Protecting Your Health Information’ document is for your reference. Please read over all of the information and fill out whatever pertains to you on the ‘Terms of Acceptance’.
3) Legal Assignment of Benefits Form:
This document allows us to bill your insurance for you and accept assignment of benefits that they provide. Please fill out whatever pertains to you, read, and sign at the bottom.