Patient Forms

Request for Medical Release (PDF) – Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Authorization and Consent to Treatment (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. 

Preferred Contacts (PDF) – Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.

Patient Registration Form (PDF) – We ask that all new patients complete this form and either email, fax, or bring with you on the day of your appointment.

Office Policies

Office Policies (PDF) – Provides information about practice hours, sick appointments, walk-ins, patient balances, telemedicine, co-pays, self pay, mail order prescriptions, referrals, cancellations, insurance change, and other important information. Please make sure to read this.