Patient Registration Forms & Privacy Notices

If you are a new patient, please fill out the 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 Registration Forms

Patient Forms

Medical Records

A medical release waiver must be signed in order to obtain a copy of your medical records or to have them sent to another health care provider. If you are requesting that your records are sent to another provider we ask that you supply us with their name, address, and phone number.

We charge $10.00 per page for forms that need to be completed, $20.00 for the first 40 pages that need to be copied and $.25 per page after the first 40.

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.

  • Patient Rights & Responsibilities

    Privacy Notices

    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.

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