New Patient Request Form

Authorization for Release of Medical Information

Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment

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

Autorización y Consentimiento Para el Tratamiento

Preferred Contacts

Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.

Contactos Preferidos

Virtual Visit Policy

This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.