Patient Forms

 

You may fill out and submit patient forms online electronically using the button below.

OR

Fill out and print the form below and bring it to the office on the day of your child’s first visit. 

HIPAA Notice (English)

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