Patient Registration Forms

The following forms are required for both new patients and returning patients who have not been seen by our providers in three (3) years or more.

You can complete the following fillable PDF forms online and print them or you can download and complete them for your first visit. These forms are not e-sign forms. If you prefer, you can also access the Patient Portal and complete the forms online. If you have questions about accessing the patient portal, contact us.

Required Forms

• New Patient Registration Form

• HIPAA Form

• Financial Policy

Additional Forms, if needed:

• Minor Consent Form

• Release of Records Form

• Credit Card Authorization Form

Accepted Insurances

Check the current list of accepted insurances. If you have questions, please reach out to us at 931-528-0002.