Now you can fill out your patient history and registration form before coming to the office. No more clipboards in the waiting room! Before your first visit do the following:
Complete the appropriate form below. The form links will take you to a secure form site so that your information is submitted through the Internet safely, just like with online banking. In addition, your name, date of birth and social security number have an additional level of encryption. If you prefer, you can just use 000-00-0000 for your social security number and give us your actual number in person when you come for your first appointment. You must answer all questions so use “none” or “N/A” if you do not have an answer. When you complete the form, you will be returned to this web site.
- Adult Patient Registration and History (18 years and over)
- Adolescent Patient Registration and History (10-17 years)
- Child Patient Registration and History (newborn to 9 years)
- Policy Holder Information Form (complete in addition to the appropriate form above)
Prepare for your first visit. Read How To Report Symptoms in preparation for your office visit. Some patients find it useful to jot down a list of concerns to bring to their first visit.