Online Patient Forms

New patient forms

Save time by completing your patient forms online before your appointment.

Step 1
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New patient registration View

Step 2
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General health assessment View

Step 3, if needed
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Other patient forms View

Telehealth forms

Telehealth is available to all new and existing patients

Telehealth consent form
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Behavioral wellness counseling services

Below two forms require your signature. Use your mouse or complete the forms using a touch screen device (smart phone, tablet) for the signature.

Behavioral wellness informed consent form
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Behavioral wellness notice of privacy practices
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Nutrition services

Thriving with diabetes assessment form
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Health risk assessment forms

Health risk assessment form
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Electronic signature required for forms below

Submitted online, no printing required. The forms below require your electronic signature. Complete and sign using a touch screen device (smart phone, tablet, touch screen computer, or a laptop/desktop with a mouse) for the signature.

Authorization for release of medical records
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Authorization for disclosure of medical information
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Credit card authorization cancellation
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Payment plan application
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Other forms

Select the location to view the forms

Insurance coverage of physical exam
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Self-pay coverage of physical exam
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Authorization not to file insurance
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Credit card authorization
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Discount card agreement
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Don't delay the care you need.

Open 7-days a week with same-day appointments.