Patient Forms

Patient Registration Forms

  1. Welcome Letter
  2. Patient Information Form (required)
  3. Medical History Form (required)
  4. Cancellation/No Show Policy Form (required)
  5. Financial Policy Form with Privacy Acknowledgement (required)

Other Forms

  1. Medical Release
  2. Privacy HIPAA Policy (English)
  3. Privacy HIPAA Policy (EspaƱol)
  4. Consent to Share Health History Information
  5. Authorization for Treatment

Established minor patients may be seen with an adult other than a parent/guardian if an Authorization to Treat form has been filled out and brought in for office visits. New Patient, Pre-op and Surgical appointments must have a parent or legal guardian present.