Resources

Prior to your first visit please print the following forms, complete, sign, and bring them with you to your appointment.

There are 4 separate forms, the last of which is 2 pages, so you should have 5 pages total when complete.

• Acknowledgment of Notice of Privacy Practices
• Medical Release Auth./Financial Responsibility & Insurance Assignment
• New Patient Information
• History & System Review (2 pages) –OR– Youth History & System Review (2 pages for 12 and under)