Online Patient Registration
PATIENT REGISTRATION FORMS
You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed all of the forms, please make sure to press the SUBMIT button at the bottom of the screen to automatically send the information directly to our patient portal. 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 it.
PLEASE NOTE THAT WE WILL BEGIN ASSESSING A 3% PROCESSING FEE ON ALL CREDIT CARD PAYMENTS ON OCTOBER 1, 2026. THIS DOES NOT APPLY WHEN YOU USE YOUR DEBIT OR HSA TYPE CARD WITH A PIN.
MEDICAL RELEASE FORM – THE MEDICAL RELEASE FORM IS NOT PART OF THE PATIENT REGSITRAITON PAPERWORK AND DOES NOT NEED TO BE COMPLETED UNLESS YOU ARE SPECIFICALLY REQUESTING A COPY OF YOUR MEDICAL RECORDS.
STOP: This form is NOT part of our PATIENT REGISTRATION. **If you have contacted our office requesting a copy of your medical records and we have requested you to complete the online form, click on the link below, complete the entire release form and click submit.