Welcome to our New Patient Packet page!
We're delighted that you've chosen us for your healthcare needs, and we're excited to get to know you better.
We know that filling out forms isn't always the most enjoyable task, but rest assured that this one will help us provide you with the best possible care. We're here to support you every step of the way, so don't hesitate to reach out if you have any questions or concerns.
Please take a moment to fill out the necessary fields. Fields marked with an asterisk (*) must be filled out.
As you progress through each section, click "next" to move forward and complete the entire packet.
When you're finished, click "submit" to send us your information and take the first step toward better health and receiving your top-quality care you deserve.
Thank you for choosing us as your healthcare provider, and we look forward to building a long-lasting relationship with you!
RESPONSIBLE PARTY OR PRIMARY INSURANCE SUBSCRIBER
If Not Self (Otherwise leave blank)
Notice of Privacy and Authorization Form
If a copy of my personal information is needed for reasons other than immediate treatment, I hereby authorize the release of information to the following: family members, Providers, or friends, acting on my behalf.
The Legal Part...
Thank you for completing our patient packet form. We understand that the legal documents are not the most exciting part, but we're just a couple of signatures away from completing your registration.
To complete your registration, please download the legal documents by clicking on the button below. You can sign the documents using multiple methods:
Print the document, sign it, take a picture of it, and upload the picture here.
Use a program like Adobe Reader to sign the document electronically. To do this, open the document in Adobe Reader, click on 'Fill & Sign,' and follow the instructions to add your signature.
If you need any help with filling out the documents, you can find our contact information on the bottom of this page.
If you prefer, you can also come to the clinic to pick up a physical copy of the documents and sign them in person. However, this may delay your registration.
Thank you for choosing our clinic, and we look forward to seeing you soon!
Please ask us how to get to chat with us through the patient portal