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New Patient Forms

NEW PATIENTS MUST COMPLETE ALL THE NEW PATIENT FORMS

 

What if I don’t have a Primary Care Physician (PCP)? 
We still need this form submitted – just check the box “I do not have a PCP”.

Please make sure you sign, date and submit all your forms.
A prompt will let you know that the forms have been submitted properly.
We look forward to seeing you!

PLEASE SUBMIT THE FORMS ELECTRONICALLY

It is important to electronically “submit” the forms instead of printing them yourself. If you print them and bring them in, it may result in having to to re-do the forms. These forms are a legal requirement in order to be seen as a patient at this practice.
All patients must complete all the New Patient intake forms prior to their preliminary evaluation.

How do I sign the online forms?

You can use a mouse to sign or your finger when signing on a mobile device, or track-pad enabled device (laptop, tablet).
If you don’t like your signature, just click ‘clear’ and try again.

Can I use initials, an ‘X’ or a line as a signature?

YES!! Your signature doesn’t need to be pretty or just something to indicate you ‘signed’ the document. See the examples provided

 

new patient Forms – please fill out and submit all forms