Patient Registration Forms & Privacy Notices
If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.
*New Patients: Please bring both the Printable New Patient forms AND the Patient HIPAA & Consent forms with you to your appointment.
- Printable New Patient
- Formularios de Inscripción de Pacientes
- Formulario de Consentimiento
- Printable New Patient - Chinese (新的病人表格)
- Medical Records Release
- Request for Disability, FMLA or Life Insurance
- Patient HIPAA Acknowledgement - English
- Formulario de HIPAA para el paciente
- Patient HIPAA Acknowledgement - Arabic (موافقة شاملة على تلقي الرعاية والعلاج)
- Patient HIPAA Acknowledgement - Chinese (患者HIPAA和同意)
If you have Medicare or are Medicare eligible, please print and bring these forms with you:
Patient Rights & Responsibilities
We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.
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 (provided for you at your first visit)
- Aviso Sobre Las Practicas De Privacidad (proporcionada por usted en su primera visita)
These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here: