Patient Resources

Want to save time? Please print our office forms at your home or office. Bring them completed to your child's first appointment. Please contact us with any questions.

Patient Registration & Consent Forms:

• New Patient Registration Form
• Consent to Treat
• Financial Policy and Guarantor Statement of Responsibility
• Preferred Contact & Consent
• Authorization for ePrescribe, Pharmacy Benefits Manager, Authorization for PPO and HMO
• Acknowledgement of Receipt of Notice of Privacy

Please fill out one of each form/consent per family with the names of each patient listed.

Patient Medical History:

• Medical History

Please fill out one Medical History form per patient.

Appointment Policy:

• Appointment Policy

Patient Privacy:

• Notice of Privacy Practices

This notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please review this notice carefully. The privacy of your medical information is important to us.