Please print and fill out prior to your visit. 

Registration Form

Provide us with your contact information to get started before your appointment. 

Initial History Form

esigned to provide health care practitioners the resource they need to document activities within the typical well visit, support proper coding, and secure appropriate payment for performed services.

Release of Medical Records

The medical record information release (HIPAA), also known as the ‘Health Insurance Portability and Accountability Act’, is included in each person’s medical file. This document allows a patient to list the names of family members, friends, clergy, health care providers, or other third (3rd) parties to whom they wish to have made their medical information available. If anyone would ask for medical information regarding a specific patient and their name is not listed on the HIPAA form, they would not be privy, by law, to any of the patient’s information under any circumstances. The document also provides the ability for healthcare providers to share information between each other. This document may be revoked and/or reassigned at the discretion of the patient at any time.