Patient Registration Forms & Privacy Notices
If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.
If you are a new patient, please complete the patient registration, patient consent and patient information forms listed below, and bring them with you when you come for your initial visit.
- Patient Registration
- Patient Medical History Information (Adult)
- Pediatric Health History (Child)
- Patient Consent
- Patient HIPAA
- Patient Prescription Policy
- Medical Records Release Authorization
- Well Woman Exam History
- Well Male Exam History
- Patient Satisfaction Survey
- Medical Records Request
Patient Rights & Responsibilities
We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.
This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
- Notice of Privacy Practices (provided for you at your first visit)
- Aviso Sobre Las Practicas De Privacidad (proporcionada por usted en su primera visita)
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