Please complete the necessary forms as needed. You can fill them out online for in-office or telemedicine visits or download them here to print and complete by hand.
The information you submit in our HIPAA-secure forms is protected health information and will be used only by this office unless you provide a written release.
**Please do not use use your auto-fill function, it creates a problem for some users that prevents advancing and completing the form**
Complete this intake form if you are scheduled for a consultation for COVID-19 prevention or treatment
New Patient Intake
Express Visit Intake
In-Depth Follow-up Visit Intake
Education Visit Intake (for out-of state)
Medical Records Release Form
Please contact the office