Print and fill out these medical forms and bring them with you to expedite your check-in process.
|Patient Registration||Download Patient Registration||Descargar||下載|
|Advance Beneficiary Notice (ABN)||Download Advance Beneficiary Notice||Descargar||N/A|
|Patient Consent Form (HIPAA)||Download Patient Consent Form||Descargar||下載|
|HIV Consent Form||Download HIV Consent Form||N/A||N/A|
|Medical Release Form||Download Medical Release Form||N/A||N/A|
|Medical History||Download Medical History||N/A||N/A|
Paying by Credit Card?
Please fill out this form, bring it with you, email or fax it to us.
|Credit Card Authorization Form||English||N/A||N/A|
What you’ll need on your visit:
|All current insurance cards|
|One (1) Official picture ID (Driver’s license, passport…)|
|Co-pay is expected prior to being seen, no personal checks acceptable.|
|Please arrive on-time|