Forms & Policies

Please select the Patient Registration form below based on the patient’s age.

Registration Forms submitted on-line will be processed within 24 business hours Monday-Friday.

New Patient Registration Form for under the age of 18 (online version)

New Patient Registration Form, ages 18 and over (online version)

The form may be printed at home and brought to your appointment.

Registration Form (print version)

Authorization to Use and Disclose PHI

Consent to See and Treat

Divorced Parents – Informed Consent

HIPAA ~ Acknowledgement Form Minors

HIPAA ~ Acknowledgement Form 18+

You’re 18 now… What does HIPAA mean to you! – A guide to understanding the privacy of your medical records

Notice-of-Privacy-Practices

Policy regarding WELL EXAMS / ANNUAL PHYSICALS

Patient Rights and Responsibilities

Referrals Policy

Advance Beneficiary Notice (ABN)

Inclement Weather & Cancellation Policy

Practice Policy and Procedures