Patient registration and COVID-19 Consent Form

If possible, we ask that you preregister with our office by filling out our secure online Patient Registration  located at the bottom of this page.  After you have completed the form, please make sure to press the “Complete” and “Send” button to transmit your form to us.  Please do not print a copy of the registration form.

IMPORTANT – The online registration includes consent for the following forms.  Please take a moment to read through them:

  1. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.  Please review our Notice of Privacy Practices (HIPAA).
  2. In order to maintain social distancing, we are implementing Telehealth consultation and follow-up appointments.  We ask that you review the Telehealth Consultation Consent Form. 
  3. Due to COVID-19, all patients who will be seen in our office will need to review the COVID-19 Consent Form.
  4. FOR MINORS: All patients under the age of 18 must be accompanied by a parent or guardian at the consultation visit.

Patient Registration