Patient Registration

We are required by law to inform you about your privacy rights and you may click on Privacy Policy (HIPAA) and download a copy or ask for a copy at our office, in addition we ask that you sign our Business Policy and Patient Agreement indicating that you have had this opportunity.

Please take this time to read the information carefully, complete the forms and bring them with you to your first appointment.

    1. Patient Information Sheet for Child / Adolescent
    2. Authorization for Release or Exchange of Information
    3. Business Policy and Patient Agreement
    4. HIPAA Signature Statement
    5. Financial Responsibility (Complete this form only IF someone else is assuming financial responsibility.)
    6. Special Contract (This is required IF parents are separated, divorced, pending divorce or engaged in litigation)

 

    1. Patient Information Sheet for College Students
    2. Authorization for Release or Exchange of Information
    3. Business Policy and Patient Agreement
    4. HIPAA Signature Statement
    5. Financial Responsibility Form (Complete this form only IF someone else is assuming financial responsibility.)