Patient Registration Forms & Privacy Notices
If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.
- Patient Registration
- Patient Consent
- Patient History
- Obstetrics and Gynecology Patient History Questionnaire
- Patient Financial Agreement
- Medical Records Release
- HIPAA Acknowledgement & Disclosure Consent
Formularios para Pacientes Registro
- Forma de Registro para Pacientes
- Forma de Consentimiento del Paciente
- Historia Medica Pasada
- Autorización para el suministro de información
Patient Rights & Responsibilities
We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.
This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.