Patient Forms

New Patients

Please print, fill out and bring to your first appointment:

1. Confidential Health History (3 pages)
2. Registration Form
3. Financial Policy Agreement

Returning Patients

Prior to your first visit in 2010, please update your health history and bring to your appointment:

1. Returning Patient Health History Update (1 page)
2. Registration Form
3. Financial Policy Agreement

All Patients

For any appointment, please bring:

1. A photo identification card
2. Your current insurance card

and be prepared for any co-payments your insurance plan requires; co-payments are due on your date of service.

Directions for your convenience.

Authorization for Release of Medical Records

The following form requiring your signature is necessary before any records can be released:

• Authorization for Release of Medical Records