New Patients

NEW PATIENT FORMS NOW AVAILABLE ONLINE

Electronic & Downloadable Patient Forms

We are excited to announce that our clinic is now offering the option for new patients to complete their forms electronically or download and print them at home. This will make the registration process more convenient and efficient for our patients. We encourage all new patients to complete their forms prior to their first appointment to ensure a smooth check-in process. If you have any questions or concerns, please don't hesitate to contact us.

Patient Forms

- Patient Registration (Español): Electronic | Download

- Consent to Treat: Electronic | Download

- Consent to Treat (Español): Electronic | Download

- Consent for Telehealth Consultation: Electronic | Download

- Authorization to Release of Medical Records: Electronic | Download

- Health History Questionnaire: Electronic | Download

- Privacy Policy: View here

- Notice of Privacy Practices: Electronic | Download

- Notice of Privacy Agreement to Treat: Electronic | Download

- Consent for Treatment with Buprenorphine/Naloxone: Electronic | Download

- Agreement for Treatment with Buprenorphine/Naloxone: Electronic | Download

- Release of Medical Records: Electronic | Download

- Acknowledgement of Notice Practice (Español): Electronic | Download

- Acknowledgement of Practice Policies and Consent: Electronic | Download

- Patient Practice Policies: Download

- Telemedicine Policies and Procedures: Download

Weight Loss Program:

- Patient Information: Electronic | Download

- Obesity Program Consent: Electronic | Download

- Consent For Use of Anti-Obesity Control Medications: Electronic | Download

- Authorization for Disclosure of Health Information: Electronic | Download

- Why I Want To Lose Weight...: Electronic | Download

- New Patient Medical History: Electronic | Download

Completing Your Health Information Is Easier Than Ever with Our Electronic and Downloadable Formats.

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