New Patient Forms
If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.
Patient Forms- Forms must be completed by legal guardian (Print & Complete All Forms Prior To First Office Visit)
HIPAA Privacy Form
Office Financial Policy Form
Relative or Non-Guardian Release Form ( For Non-Parents Only)
If someone other than the legal guardian of the child will be bringing them to the office for an appointment (for example: grandparent, aunt, uncle, or family friend) the following form below MUST be completed & signed by the legal guardian in order to see your child.
This gives us permission to share your child's private health information with the accompanying adult as well as discuss treatment options. The legal guardian must also complete the above forms and send with the patient on the first visit. We appreciate your compliance with this matter and please contact our office if you have any further questions.
Relative or Non-Guardian Release Form