For your convenience, our new patient paperwork is available for download before your first appointment. Click on each link below to open the form in a new tab.
Please print, complete, and bring to your first appointment with us:
- Patient Data Sheet
- Medical History Form
- Behavioral Health Information
- HIPAA Patient Permissions
- Combined Acknowledgement Page
(for Notice of Privacy Practices, Patient and Clinic Rights and Responsibilities, and Billing and Collection Patient Information forms listed below).
Please download the following forms for your records:
- Patient Centered Medical Home Brochure
- Billing & Collection and Automated Messages Information
- Notice of Privacy Practices
- Summary of Notice of Privacy Practices
- Patient and Clinic Rights and Responsibilities
We cannot accept new patient forms by U.S. mail, fax, or email.
I work full time helping the disabled but still couldn’t afford the care I needed—until now.Deb, Patient and Home Health Aide