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.
Registration Forms
- Financial Policy
- Informed Consent
- Infant Health History
- Adult Immunization Release
- Pediatric Health History Form
- Medical Records Release
- Medicare Second Payor
- Patient Fee Letter
- Initial Clinical History and Physical Form
- Patient Consent and Registration
- Patient HIPAA Acknowledgement and Consent
Formularios de Inscripción de Pacientes
- Póliza Financiera
- Formulario de Inscripción
- Medicare Secundaria Pagador
- Informacion Historial de Salud
- Consentimiento Del Paciente Para Communication Financieras
- Historial de Salud niños de 2 a 16 anos de edad
- Autorización de Entrega de Information de Cuidado de Salud
- Formulario de Consentimiento Para Adultos - ImmTrac
- Concentimiento Para Pacientes
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
Derechos y Responsabilidades del Paciente
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.
- Notice of Privacy Practices (provided for you at your first visit)
- Aviso Sobre Las Practicas De Privacidad (proporcionada por usted en su primera visita)