Patient Forms

 

You may fill out and submit patient forms online electronically.

OR

Please print and fill out Patient Information, Medical History, and HIPAA Consent forms and bring them to the office on the day of your child’s first visit. 

Patient Information

HIPAA Consent

Medical History (English)

HIPAA Notice (English)

Medical History (Spanish)

HIPAA Notice (Spanish)

In order to maintain the integrity of the records and safeguard the confidentiality of protected health information, please use the encrypted form below to send us patient forms, x-rays, medical and dental records, or any other types of ePHI.  The following file formats are preferred: 

X-Rays - Dexis (.dex), Dicom (.dcm) or JPEG (.jpg)

Dental and Medical Records - PDF (.pdf)

If you need to send us more then 5 files, you will need to use this form multiple times or zip your files, learn how here.

Referring Doctors