New Patient Registration

NOTE: PDF, Adobe Reader required.

Forms

1. After you Request an Appointment you will be emailed New Patient General Info & Health History Forms.  

2. Fill-in your information and Save a copy to your computer.

3. Print a copy, provide your signature where required and bring the forms with you to the appointment.

NOTE: Please give yourself 30 minutes to complete the forms.

Prior Medical Records
If prior medical records are needed for your case the following two documents will assist you to acquire copies and having them forwarded to my office or directly to you.

2017 Instructions-for-How-To-Request-Copies-of-Your-Medical-Records

2017 Medical Record Release Form Adult_Fill_In

2017 Medical Record Release Form Minor_Fill_In

Insurance Verification
Fill in this form and submit your insurance information for us to determine your available benefits. 

Request an Appointment

3 Ways to Request An appointment:
Schedule Online
Email the Clinic
Phone the Clinic:  530-536-5084