NEW PATIENT INTAKE FORMS (English)

 Please feel free to print out, fill in the form and bring with you to your visit.

Please make sure you fill out all four pages. 

If your insurance does have a deductible, we will ask for a credit card on file. 

Part 1 of 2 (pdf)

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Part 2 of 2 (pdf)

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new patient intake forms (spanish)

Parte 1 de 2 (pdf)

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Part 2 of 2 (pdf)

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Release of records

Authorization to obtain records (pdf)

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Consent to treat minor

Consent for Treatmen of Minor (pdf)

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HIPAA Right of Access Form for Family Member / Friend

HIPAA Right of Access Form (pdf)

Download

Advance Health Care Directive Form