Registration

We know that your time is valuable, to help speed up the registration process, we ask that you print out, complete and bring the following forms with you to your first appointment. By filling out these forms before your first visit, we can keep the time you spend at the reception as short as possible. In addition, please bring any your insurance card, co-payment, and all medications you are taking currently. Also, if you have a copy of your current medical record, please bring it, we can also help you fill out a form requesting the transfer of your medical record.

There are the 5 required documents in the registration package
[click here to download all forms]

1) New Patient Registration Form (1 page) - Please fill this out as completely, including your contact, email, your emergency contact and insurance information.

2) Notice of Privacy Practices (2 pages) - Effective as of April 14, 2003, there are a set of federal regulations (HIPAA) concerning the appropriate use of information related to health care. Part of these regulations stipulates that you must be informed of the impact of this legislation, so you will be asked to sign a form to acknowledge receipt of this document. Feel free to contact us with any questions, since we are not allowed to provide care unless these guidelines are complied with. This form is for your information only - you do not need to return it to us.

3) Acknowledgement of Privacy Policies (1 page) - This document outlines the policies of our practice with regard to health insurance, payment for services.

4) Acknowledgement of Financial Policies (1 page) - This document outlines the policies of our practice with regard to health insurance, payment for services.

5) Request to obtain copy of your past medical records (1 page). Availability of your past medical records ensures continuity of care.

We hope that getting this paperwork done ahead of time makes your visit easier. Please feel free to contact us if you have any further questions.