Patient Information

New Patient Forms

Please Print And Complete All And Bring To Appointment:

• New Patient Registration Form PDF-English - required
• Formulario de registro de pacientes nuevos PDF-Spanish - requerida
• Health Questionnaire PDF-English - required
• Cuestionario de Salud en español PDF-Spanish -  requerida
• Medication Form PDF-English - required
• Formulario de medicación PDF-Spanish - requerida
• Medication Refill Policy PDF
• HIPPA Privacy Notice PDF-English - signature required on forms
• Aviso de privacidad de HIPPA PDF- Spanish - firma requerida en los formularios

If you are visiting our office for the first time, we will need to obtain some vital information. Our receptionist will ask you to complete an information form and a medical history form. Forms are necessary for the doctor to obtain essential data about you.

All information given to our office is confidential and protected by the Privacy Act.

By Appointment Only

As a necessity, doctors must work by appointment. Every effort will be made to see each patient in the earliest possible time frame. Should a situation arise where immediate treatment is needed, our staff will make a strong effort to schedule a same day appointment. If you are unable to keep an appointment, we ask that you contact our office within 24 hours in order for our staff to utilize your time period for another patient.

Emergencies

After hours, weekends, and on holidays, there will be an answering service available in case of an emergency. Please limit after-hours calls to emergencies only. Thank You.

No Smoking or Cell Phones Please

The building(s) our office(s) is located in has a “NO SMOKING AND NO CELL PHONE POLICY”. If you must leave the building to smoke or use your cell phone, please inform our receptionist and she will reserve your place for you.