You must fill out these FIVE forms within 24-48 hours of your scheduled appointment. Note: forms work best on laptop or tablet.
- Medical History (to be completed by Parent or Adult Patient
- New Patient Survey (choose either 12 & under OR 13 & above)
- Parent Input Form
- Annual Practice Consent (choose either under 18 OR 18 and older)
- Medical Records Request/Release
Please be advised that by providing this form for you to contact our office(s), we are not confirming an appointment nor establishing a physician-patient relationship. As a user of this mode of communication and of our website, you assume all risks with placing confidential information into this portal. Our office will follow up with you within 24 to 48 business hours. Please note: We may not see submitted forms for 24 hours depending on when the forms were completed. For any safety concerns, thoughts of self-harm or suicide, or severe medical symptoms please call 911 for medical emergencies or text “help” to 741-741 or call the National Suicide Hotline at 1-800-273-8255, https://
*Not intended for use by the general public but only for patients with scheduled appointments.