Patient Information and Forms

Appointment Checklist

• Please bring in a copy of the patients insurance card and the drivers license of the primary cardholder.
• Legal Guardians should bring proof of guardianship.
• If someone other than the parent or legal guardian brings in a child under the age of 18, they should have a written note of consent to provide care for that child.
• A patient who is new to our practice should arrive 15 minutes prior to their appointment time to complete paperwork. You may also print the paperwork from this site and bring it with you to the appointment.

• HIPAA Privacy Notice Acknowledgement
• HIPAA Consent Form 
• Insurance Update Form
• Annual Demographic Update Form

Online Forms for New Patients (please complete all tabs)

•  New Patient Forms

Other Health Forms 

• Health Appraisal Form (For Daycare, preschool, school, camps, etc.)
• Sports Physical Form (pre-participation form for sports or sport camps)

• Alternate Caregiver Consent Form

• Medical Records release form 

• Consent To Share Information - (Patients 18 yrs and older)