In order to expedite the registration process, please fully download, print and complete.
Please remember to bring your insurance card and proper form of ID with you.
For new patients and existing patients that have information changes:
If you need to request the release of the patient record of care from a previous provider:
(Transfer of Record).
records to another facility/provider. You may want to contact previous providers to discuss potential cost.
If you feel
there may be an occasion where your child will
be brought by a relative, sitter, etc:
You may FAX or Mail the completed forms to us or bring them to your initial office visit.
you have changes to your current information
only, please complete
For a printable copy of our Privacy Statement:
If you have any non-medical questions, send your request to the attention of our
NOTE: Information sent to us via email is being disclosed by you through an unsure manner.
Though we are the address recipient, we cannot state subject matter contained in email
transitions is 100% protected from unauthorized viewing as required by HIPAA.
We, therefore, ask that messages which may contain protected health information that
is personal, sensitive and confidential not be remitted to us through email transmissions.
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