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PATIENT FORMS FOR

Registration

Please Read this Page Closely

You have two options for submitting our new patient registration.  Depending on your preference, you can choose: 1) Electronic Registration or 2) Print, Fill-out, and Bring With. Please review the options below and decide which way you would prefer to fill out the forms.

If you choose electronic registration, you will be asked to type your child’s name and date of appointment. If you have any questions, please do not hesitate to contact us.

Option 1) Electronic Registration

Please allow yourself enough time to complete the form in a single sitting. If you start the form and then leave, the system may require you to start over. Estimated available time is 30 minutes. There are several pages of questions, use the arrow key at the bottom of the page to advance. When complete, hit the SUBMIT button to send the information to our office. Your signature will be added to the form when you arrive at the office.

Option 2) Print, Fill-out, & Bring With

If you prefer, you may print these forms so you can fill them out at home. Simply click on the buttons below to open them, they will open in a format which will allow you to view and print them from your web browser.

Please print 1) the “Patient Information Form“, and 2) choose one of the two available medical/history forms, depending on your child (or children’s) age. Use the “Child Form” for children under age 12; use the “Teen Form” for children 12 and older.

Print Patient Information Form (Required for All Ages)

Open Patient Information Form

Note:  The document will open in your Internet browser, in a separate tab; You can then choose to print it from there or download it to your computer.  The Patient Registration Form is a large file, so please give it a bit to load.

Print Child Form (Under 12 Yrs)

Open Child Form

Note:  The document will open in a separate tab in your Internet browser.  You can then choose to print it from there or download it to your computer. 

Print Teen Form (12 and Older)

Open Teen Form

Note:  The document will open in a separate tab in your Internet browser.  You can then choose to print it from there or download it to your computer. 

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