Patient Registration Forms & Privacy Notices
To assist in the registration process at your appointment check-in time, we recommend filling out the registration paperwork prior to your appointment. Please have available a current insurance card and driver’s license or other acceptable form of ID at check-in. In addition, we recommend arriving 10 minutes early to your appointment time to help ensure we have all necessary information to provide you quality care and treatment.
- New Patient Registration Forms (except HIPAA)
- Current Patient Annual Physical
- Medicare Annual Wellness Visit
- Patient HIPPA Acknowledgment & Disclosure Consent (Print)
- HIPAA Consentimiento para el Paciente (imprimible)
- Authorization for Release of Medical Records (as needed)
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)
These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here: