New Patient Pre-Registration2018-10-08T15:34:53+00:00


If you are a new patient, you may preregister with our office by filling out our secure online Patient Registration Form and Medical History. Once finished, please make sure to press the Submit button at the bottom to send us your information. On your first visit to our office, we will have your completed registration and medical history available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. After you submit your online preregistration, don’t forget to print and fill out the Financial Guidelines/HIPAA and Patient Consent forms. You’ll need to bring these in with you to your first appointment.

(Please note: When You click the Go button, you will be redirected away from our website to

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Financial Guidelines & HIPAA Statement – Please click here to download

Patient Consent for Use & Disclosure of Protected Health Information – Please click here to download

About Our Practice

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Contact Info

12345 West Elm Street

Phone: 1.888.456.7890

Fax: 1.888.654.9876

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