Below you will find New Patient / Update Forms

Patient Information Form:
Please fill out this form as completely and accurately as possible. Click Here to download this form.

Privacy Form:
Filling this form out gives or denies us permission to speak with persons, other than you, about your account and medical information. Click Here to download this form.

HIPPA Form:
This form makes you aware of your rights under federal HIPPA guidelines. Please read and sign where indicated. Click Here to download this form.

Please bring these completed forms, a picture ID, and your medical insurance cards with you when you come in for your first appointment. If you have Medicare, please bring any secondary policy cards, except Medicaid , with you as well.

REMINDERS

• All co-payments, deductible, coinsurances and outstanding balances are due at the time of service. If you have an insurance that we do not participate with, we will collect the full amount of charges for the day's services.
  
  
• If you cannot keep your appointment, we ask that you try to notify our office at least 24 hours in advance.
  
  
• If you have questions about these forms, please contact our office at (281)359-6000.