Patient Forms

 

For your convenience, we have forms available for you to fill out prior to your appointment.  
You can either download, print and fill out the form and bring it with you to
your appointment or you can submit it electronically.

 

Patient History Form - Adult (Printable)

 

Patient History Form -  (Electronic)
 

Patient History Form - Minor (Printable)
 

Patient History Form - Minor (Electronic) 

  

Notice of Privacy Practices Form (Printable)

 

Please note: Insurance may cover none or only part of your fees. If we do not accept direct  payment from your insurance plan, you will pay our office at the time of service and submit your receipt for reimbursement from your insurance company. If your insurance does not pay as expected, you are ultimately responsible for all charges. We cannot be responsible if you are not eligible for benefits. We will be happy to assist you with your claims, please give any forms to the receptionist. Thank you! We’re glad you’re here.