Patient Registration Form

The following forms and corresponding instructions have been provided for your convenience.  Please print, complete, and sign the following forms prior to your first appointment.  Alternatively, you can use our online New Client Registration Form;  your information will be imported securely and automatically into our Account Management system.

New patients can save time during their first appointment by completing the Patient Registration form prior to their visit. Simply print out the Patient Registration form, fill in the information requested, and bring the completed form with you to your appointment.

The first three pages of this form:

  • New Client Information
  • New Patient Agreement
  • Consent to use PHI

must be completed and signed prior to your first appointment.  The fourth page

  • Credit Card Authorization

can be completed during your first appointment.

Click the “Download” link to fill in the form online, and then bring your printed copy with you to your first appointment.

Download (PDF, 254KB)