Patient Forms

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.

Patient Forms

Authorization and Consent to Treatment – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.

HIPAA Authorization to Release Patient Information – Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Patient Registration Form (English)

Patient Registration Form (Spanish)


Office Policies

Financial Policy – This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Notice of Privacy Practice – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

Notice of Privacy Practice (Spanish) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.