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Patient Forms

Want to make your registration process easier?

Just print out and complete the registration forms below and bring them with you to your first appointment.

Additional forms will be provided in our office, but completing these forms ahead of time will speed up the registration process.

Before your first visit please come prepared with the following items:
Insurance card
Government Issued Photo ID
Doctors Prescription (If Applicable)

Patient Forms in English

Patient Registration Packet

Permission to Treat Minor Without Parent

Notice of Privacy Practices Acknowledgement

Formas En Español

Registro De Paciente

Aviso De Practicas De Privacidad

Permiso Para Tratar a Menores Sin Padre/Tutor Legal

Payment Options

We accept cash, checks, and all major credit cards.

We do expect copays at the time of service. Coinsurance and deductible payments may be made directly to the clinic where services were rendered, via US mail, phone payment, or secure web payment.

Pay Now

If you have an insurance company that we do not participate with, we are still happy to see you; however, payment is expected at the time services are provided.

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Let Us Help You

We want to help you meet your financial responsibility without undue hardship.

Please call and speak with one of our staff by clicking below if you need to arrange a payment schedule.

Give Us a Call

This can alleviate anxiety and help keep your account in good standing.