Patient Registration Forms

Please print and complete documents 1-6. Please complete form 7 if forms are being prepared for a pediatric patient. Additional paperwork may need to be completed at the office.

1. Adult Health History Questionnaire OR Pediatric Health History Questionnaire
2. Primary Care Health History Questionnaire
3. New Patient Registration
4. Consent for Treatment
5. HIPAA Disclosure Authorization
6. Authorization to Release Medical Records or Authorization to Release Medical Records (Español)
7. Designation of Health Care Surrogate for Minor (if a pediatric patient)