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.
- Patient Registration
- Patient Consent
- Medical Records Release
- Patient HIPAA Acknowledgement and Consent
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)
Prescriptions and Forms
For all prescription refills, patients should contact their pharmacies directly. Your pharmacies will in turn contact our office for refill information, if necessary. Patients should allow three business days to process all prescription refill requests.
Completing Forms and Documents
Please be aware that physicians may not be able to complete outside forms during a scheduled appointment visit. Instead, patients should allow 7 to 10 business days to complete any documentation requests, including school immunization forms, adoption documentation, disability forms, etc.
What to Bring to Your Appointment
To speed your check-in prior to each appointment, please be sure to bring the following to every appointment:
- Photo ID
- Insurance information
- Insurance co-payment
- All current medications in their original container OR a list of all medications with dosages.
Patients will be asked to provide current contact information so that physicians are able to provide prompt follow-up information, including lab and test results.
These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here: