intake forms

There are seven total forms that will require your digital signature. Each form must be completed and signed before treatment can begin.

The New Patient Profile form is a multi-page form that will help the doctor understand your history and how it may impact your current condition; as such, it is the most important. If you are unable to answer a specific question, move to the next question and submit the form as is. You can review this portion with the doctor upon your initial visit.

New
Patient
Profile

1

begin part 1

Authorization
&
Release

2

begin part 2

Consent
to
Treatment

3

begin part 3

Patient
Care
Agreement

4

begin part 4

Patient
Consent

5

begin part 5

Patient
Privacy
Agreement

6

begin part 6

Payment
Policy

7

begin part 7
back