Patient Registration Form

If you are a first-time patient, please plan on arriving early so that we can complete the necessary paperwork. Please bring the following items to your appointment:

• Insurance card(s)
• Driver’s License
• Referral forms (if required)
• Any required co-payment
• Pertinent medical and surgical history information (if applicable)
• List of all prescription and over-the-counter medications that you are currently taking
• Completed patient forms (you can complete these in the office or bring them with you)

Your First Appointment

For your convenience, you may print and complete the patient forms at home before your visit.

• Patient Registration
• New Patient Form
• Assignment of Benefits
• Financial Policy
• Privacy Practices Signature Page

Below is a link to our Notice of Privacy Practices. This summary and notice describes how
medical information about you may be used and disclosed and how you can get access to this
information. Please review it carefully. The patient form packet shown above includes a form
that asks you to acknowledge receipt of this notice. You do not need to print this document. It is
provided for your information only.