Intake Form

To save time, you will find it helpful to use our secure online health history forms.  Be sure to provide your medical insurance plan as well as policy number if you would like us to validate your insurance for your appointment.


1) Please complete this:  Intake form

2) If the patient is under 18, the Consent to Treat a Minor form needs to be completed by parent or guardian.  

3) If you would like us to retrieve medical records from another provider, please complete this Medical Records release form.

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