New Patient Forms

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Dear New Patient:

Please complete all 3 forms prior to your first appointment and submit them on-line.  Make sure you submit all 3 forms to reserve an appointment time.  We urge you to contact your insurance company to confirm benefits, as we are not responsible for your benefits (After you subnit these forms, please click on Insurance tab on top).

Note: This site is secured with the leading provider of online security. Your credit card number and personal information is  kept safe from interception.

Credit Card Authorization form is required and mandatory to schedule and hold your appointment.  Without a card on file, we cannot guarantee your appointment time.  Please note, when you schedule an appointment, the reserved timer is 100% reserved for you, when  you do not show up or cancel an appointment in less than 24-hour notification, you are still responsible for our time, & you will be charged for the missed appointment. Please note, your credit card will not be charged without first notifying you of the charges.

Thank you for your time, we look forward to meeting you soon.

1. BILLING/INSURANCE FORM 
2. PATIENT INFORMATION FORM
3. AUTHORIZATION FOR CREDIT CARD USAGE

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