Patient Registration Forms & Privacy Notices

If you are a new patient, you may download and complete our registration forms in advance and bring them with you when you come for your appointment.

Registration Forms

Patient Registration Form

Patient Consent Form

Medical Records Release (as needed)

Patient Review of Symptoms

Privacy Notices

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices

Aviso Sobre Las Practicas De Privacidad

These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here:

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Contact Us

Have comments or questions? Please contact us by completing our online contact form.

Appointments

We offer the convenience of online appointments! To make an appointment request, please use our online appointment form, or simply call (804) 433-1400.