New Patient Registration Paperwork
The paperwork consists of 3 sections. You must complete all sections with a red *. If you click submit, and do not see a message confirming or “thanking” you for the submission, then please scroll up and review what section was not completed. Paperwork is not submitted unless you get the confirmation message. You will receive 1 for each section , so 3 total. Thank you!
*Please note: There is a $50 cancellation policy if you do not notify us within 24 hours of your appointment if you need to cancel or reschedule*
Patient Medical History
SECTION 2: Medical History (please make sure you click submit above and get a confirmation prior to moving forward with section2 below)
SECTION 3: Authorization/HIPAA (please make sure you click submit above and get a confirmation prior to moving forward with section3 below)