New Patient Forms

Please fill the following forms out prior to your child's initial visit. 

Otherwise, please arrive 30 minutes earlier than your scheduled appointment time. 

The first visit must always have a parent present.

If on second or later visit, someone other than a parent will be bringing a patient to their appointment: 

Bring This Form -Temporary Guardian Release

Patient Registration Forms – SEVEN in total 


1. 
Patient Information

2. 
Health History

3. 
Accident Questionnaire

4. 
Office Policies

5. 
Other Insurance Carrier Information (COB) If you have UNITED Health Care, UMR, Community Plan or CRS use this form instead United Health Care Coordination of Benefits

6. Medical Record Release

 7 The  Privacy HIPAA  form You may read the HIPAA policy HERE, or we can give you a paper copy or email you a copy when you arrive if you wish.


Please remember to take a look at our Contact Us page for information regarding our office location and directions.