Forms to fill out
Most new patients fill out these forms before their first visit.
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Patient registration
Your name, address, phone number, and who to contact in an emergency.
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Health history
Your health problems, past surgeries, allergies, and the medicines you take.
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Insurance information
Your insurance plan and member details, so we can bill your plan.
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Notice of privacy practices
A form that says you got our notice about how we protect your health information.
How to return your forms
Print your forms, fill them out, and bring them with you to your visit.
Other ways to send us your forms will be added by the clinic.
No printer? No problem.
You can fill out your forms at the office when you check in.
Your privacy
We keep your health information private. Read our privacy practices.
Before your visit
Read what to expect at your first visit, and check the insurance plans we accept.
Have a question about a form? Call us at (541) 385-7129.