New Patient Health History Form –Required

Once the entire New Patient Intake is filled out, you must hit the submit button. 

*PLEASE DO NOT FILL OUT THIS FORM ON YOUR CELL PHONE DEVICE, IT WILL NOT SUBMIT FORM. PLEASE FILL OUT ON A COMPUTER OR ON iPAD/TABLET ONLY!

PLEASE CALL OUR OFFICE WITH YOUR INSURANCE INFORMATION AT LEAST 48 HOURS BEFORE SCHEDULED APPOINTMENT.

IF WE DO NOT RECEIVE INSURANCE COVERAGE INFORMATION BEFORE SCHEDULED APPOINTMENT, YOU WILL BE CONSIDERED A CASH PATIENT.

M.V.A accident forms: Please print out forms, fill out, and bring with you to your new patient appointment.

*We DO NOT accept third party insurance.  Please notify our insurance specialist, Jessica,  if you have any questions.