Forms

As you know, there is always the required paperwork. For your convenience, we have made everything available to you online.  Please read the instructions below.

Of course, if you have any questions, we'd be glad to answer them. Either email or call us. Also, check out web site help for assistance in viewing or downloading the following forms.

First - HIPAA
We have to satisfy the government with regards to HIPAA.
After reading our Notice of Privacy Practices,
we need you to print the Acknowledgement of Receipt of Notice of Privacy Practices.  After printing, please complete and sign this form, and bring it with you to your initial appointment.

If you'd like even more information , please see our HIPAA page in the parents section.

Next - The Instructions
You may pre-register with our office by filling out our secure online Patient Registration Form and Health History Form. All  are in a PDF format.  After you have completed the form, please make sure to press the Submit button (once) at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect you.

PC Users: Our online form is a PDF document that uses Adobe Acrobat Reader plug-in that allows you to conveniently submit documents from home or work. Please download the free Adobe Acrobat Reader from Adobe's web site if it is not already installed on your system. It is important that you have the latest version of the reader to successfully use our online form.

Mac Users: You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly.  Please download the free Adobe Acrobat Reader plug-in from Adobe's web site. You must OPEN the Adobe Reader Application after installation and make Adobe Reader your DEFAULT SAFARI PLUG-IN for viewing PDF files.

And Now It's Time To Type!

Registration
First we need some information...

Health History
Now we need some history ...

Birth - 5 years old Health History

Age 6 - 15 years old Health History