Please complete and bring this form with you to your appointment:
Please review the following forms prior to your appointment:
- Notice of Health Information Practices
- Conditions of Admission
- You will sign this form when you check in for your visit to consent for us to provide our services. We are unable to make alterations to the content of this form
- Patient Rights and Responsibilities
- Authorization for Disclosure of Health Information – used to release your records to or from another office.