Registration Form
This form provides patient and insurance information. New patients are requested to complete this form and bring it for your first visit. This will expedite processing.
HIPAA Agreement
Health Insurance Portability and Accountability Act (HIPAA) passed congress in 1996 and provides guidelines for handling patient privacy. The agreement confirms your understanding of clinic policies on HIPAA (see link on the right to review a copy) and your agreement on people that may access to patient records
Medical Records Transfer
Request release of medical records into our clinic. For patients transferring from other practices to our clinic.
Medical Records Release
Request release of medical records to another physician or clinic.
Patient Referral
Please use this for Physicians or Providers that would like to refere patients to our clinic.