Registration / Patient Forms

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ONLINE REGISTRATION- New Patient

(Important: For Online Registration, print and sign "Notice of Privacy Practices" & Notice of Payment Policies" below and return them to the front desk on arrival to complete registration.

ONLINE CHECK IN - "Established" or Previously Seen Patients

(Please call the office that you wish to be seen at after you have completed the registration to notify the receptionist.)

ON-SITE REGISTRATION

Print and Complete one of these forms for On-Site Registration:

• New Patient Registration Form
• Established Patient Registration Form

Other Administrative Documents

• Medical Records Release
• Patient Confidentiality Statement

Diagnostic Testing Forms

• LAB ORDER FORM
• X-RAY / CT SCAN ORDER FORM

Drug Screen Forms

• Drug Screen Account Set-Up
• Consent for Post-Accident / Random Drug Screen
• Consent fro Pre-Employment Drug Screening