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enfrdeitptrues


Thanks for submitting our New Patient Form


It has been securely sent to our office –
we look forward to seeing you at your next appointment!

Our preferred way to receive your New Patient Forms is through our online, HIPAA-compliant secure form submittal system. Please click on the appropriate form below to complete and send:

New Adult Patient
New Adult Patient
New Pediatric Patient 0 1
New Pediatric
Patient
Birth to 1 Year
New Pediatric Patient 1 4
New Pediatric
Patient
1 to 4 Years
New Pediatric Patient 5 10
New Pediatric
Patient
5 to 10 Years
New Pediatric Patient 11 17
New Pediatric
Patient
11 to 17 Years

If you’re not able to securely send your New Patient Packet, you may print it or any individual page below and bring with you to your appointment

Click on any form icon below to download an Adobe Reader® file of that form. Where applicable, print, fill out and bring the completed forms with you at your next appointment.

ALL NEW PATIENT'S MUST BRING COMPLETED FORMS WITH THEM TO THEIR FIRST APPOINTMENT AND ARRIVE 15 MINUTES EARLY.  IF YOU DID NOT COMPLETE YOUR PAPERWORK IN ADVANCE PLEASE ARRIVE 45 MINUTES PRIOR TO YOUR SCHEDULED APPOINTMENT TIME TO FILL OUT YOUR PAPERWORK.   IF YOU DO NOT HAVE YOUR FORMS COMPLETED AT YOUR SCHEDULED APPOINTMENT TIME YOU WILL BE ASKED TO RESCHEDULE YOUR APPOINTMENT FOR ANOTHER DATE.

PDF TX 65New Adult Patient


PDF TX 65New Pediatric Patient –
Birth to 1 Year

PDF TX 65New Pediatric Patient –
1 Year to 4 Years

PDF TX 65New Pediatric Patient –
5 Years to 10 Years

PDF TX 65New Pediatric Patient –
11 Years to 17 Years

PDF TX 65Demographic Form


PDF TX 65Cancellation/
No-Show Policy

 

PDF TX 65HIPAA Form


PDF TX 65Consent to Treat Minor


PDF TX 65Financial Policy


PDF TX 65Self-Pay Policy


PDF TX 65Adult Physical Form


PDF TX 65Vaccination Policy


 

get adobe readerIf you don’t have Adobe Reader on your computer, click here for a free download