Privacy Rights

Please read our Privacy Rights then print off the acknowledgment and sign and date where indicated. Bring the signed acknowledgement to your appointment.

Financial Policy

Please read through our Financial Policy to understand your payment options and how we bill your charges.

Request For Release of Medical Information

Please print the form and fill out required information. Be sure to sign and date the form. Mail or hand carry to our office.

Authorization of Use/Disclosure of Protected Health Information

If you would like us to share your information with another person please print and fill out this form. Be sure to sign and date the form then mail or hand carry to our office.

Registration

Please fill out registration form, sign and date and return to our office.

Health History Form