Become a Patient

Patient Forms

The following are some forms you may find useful.

New Patient Request Form

Health Risk Assessment

Patients who are coming for a Medicare Wellness Exam should complete this form and bring it with them to their appointment.

Direct Primary Care Intake Form

Patients who are new to our Employer Direct Primary Care program should complete this form and bring it with them to their first appointment along with their photo ID, DPC member card, insurance card, and any prescriptions, over-the-counter medications, vitamins and supplements they are taking.

Diagnostic Center Ultrasound Preparations

Patients who are coming for an ultrasound should review this form in advance, as certain exams require specific preparations.

In-House Record Transfer Form

This form is used to ask one of our offices to send your records to another one of our offices.

Become a New Patient

We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:

  1. Make an Appointment
  2. Sign up for our patient portal
  3. Download your patient forms online through the patient portal

When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.

To make sure there are no delays in care during your first visit experience, please arrive 15 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.

Remember to bring:

  • Your insurance card
  • Valid photo ID
  • List of current medications
  • Office co-pay

In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.

For patients who are delayed and arrive late for appointment, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled.

Patient Forms

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento

Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Office Policies

Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)

Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)

HIPAA Privacy Notice