PATIENT INFORMATION

• Introduction
• First Visit
• Scheduling
• Financial Policy
• Insurance
• Infection Control
• Home Instructions
• Registration Form

Patient Registration Form

Please download and fill-out our Patient Registration Form. After you have completed the form, please make sure to bring it with you on your visit to our office. 

Our office is HIPPA compliant.  If you would like to read our entire Privacy Policy, a copy will be provided for you at your first appointment. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

NOTE:  As of August 1, 2009, a valid driver's license or picture i.d. will be required due to enforcement of The Federal Trade Commssion's "The Red Flag Rule".  This is to protect you from medical identity theft. 

Technical Note:

You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe's web site if it is not already installed on your system.