You may print the following forms from our website and bring them with you to your appointment or we can supply you copies at the time of service.
Authorization and Consent for Treatment
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
Authorization for Release of Medical Information
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Preferred Contacts Form
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Notice of Privacy Practices
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.
Financial Policy
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Virtual Visit Policy
This policy describes the process for the documentation,maintenance, and transmission of information using virtual visit technology.
Pediatric Safety & Risk Questionnaire
Click on the form below that matches the age of your child. Please fill out the form and bring it with you to your appointment.