Per Page image

New to Our Practice?

Completing our forms prior to your child's first appointment will help expedite the check-in process. These forms may be completed on online and printed or printed and completed manually. Just bring them with you and present to our front office staff when you arrive for your appointment.

  • Patient Information Sheet - This form can be completed to include up to 5 children in the family.
  • Privacy Practices (HIPAA) - This policy outlines our privacy practices as it relates to the Health Insurance Portability and Accountability Act (HIPAA). This policy does not need to be brought with you to the appointment. It is for your information only and should be reviewed prior to signing the Notice of Privacy Practices - Patient Acknowledgement form.
  • Notice of Privacy Practices - Patient Acknowledgement - This form is to acknowledge you have received a copy of our privacy practices as they relate to the Health Insurance Portability and Accountability Act (HIPAA).
  • Financial Policy - This policy outlines our billing practices, handling of missed appointments, returned checks, and when payment of co-pays and outstanding bills are expected.
  • Authorization to Treat Minor Child Not Accompanied by Parent or Legal Guardian - This form can be completed to allow your child to be treated when accompanied by someone other than the parent or legal guardian or for a child to be treated unaccompanied by an adult.

Adobe Reader is required to open our forms. If you do not have Adobe Reader you may click the icon below to download.

Get Adobe Reader