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 Patient Packet
- Medical Records Release
- Patient Consent and Registration
- Medicare Secondary Payor
- Request for Disability, FMLA or Life Insurance
- Formulario de Consentimiento
- Formularios de Inscripción de Pacientes
- Secundaria Formulario Pagador Medicare
- Patient HIPAA Acknowledgement and Consent
- Formulario de HIPAA para el paciente
- Patient HIPAA Acknowledgement - Chinese (患者HIPAA和同意)
- Patient HIPAA Acknowledgement - Arabic (موافقة شاملة على تلقي الرعاية والعلاج)
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.