Registration Forms2019-01-17T16:24:35-04:00

Forms You Will Review and Sign Before or During Your Visit

When you register to see us for the first time, you will be asked to sign a contract establishing the doctor-patient relationship between you and us. As with any contract, this creates a number of mutual rights, duties, obligations, and expectations. We take this contract very seriously, and we expect you to do the same. We will ask you to fill out a medical questionnaire which we will review during you visit. On subsequent visits, please be sure to tell us if there have been any changes in your child’s medical history since the first visit. You will also be asked to acknowledge in writing that you have been offered a copy of our privacy policy which is posted in the waiting room.

Click on the links below to review forms that we use in our office. These are proprietary forms that are not to be used other than for official business with our office. Feel free to print and complete these forms at home prior to your visit to shorten your visit.

Registration Form

Registration Form
Medical History Form
HIPPA Consent
Elimination History
Consent to Treatment