Patient Registration Forms & Privacy Notices
At your first appointment, or if you have not been to the office within the last 12 months, you will be asked to complete a patient information form, and a patient medical history form to assist our physician clinical staff in your care.
Registration Forms
Patient Disability/FMLA Forms
We will complete routine work restriction forms, disability or FMLA forms that you bring with you to your appointment within 5 business days.
- Routine forms mailed or dropped by the office will be processed within 5-10 business days and a $15.00 fee will be assessed prior to completion of the paperwork, and for each time the paperwork is required
- Complex forms and/or medical/legal letters are completed only if approved by the physician and a fee is associated with this service
- Requests for Handicap Parking Access applications presented at the time of your appointment will be completed before you leave. However, requests called in to the office will take 3-5 business days to process
Privacy Notices
This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
- Notice of Privacy Practices (provided for you at your first visit)
- Aviso Sobre Las Practicas De Privacidad (proporcionada por usted en su primera visita)
These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here:
