Patient Forms

New Patient Intake Form

Authorization for Release of Medical Information (PDF)– Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. 
Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. 
Autorización y Consentimiento Para el Tratamiento

Preferred Contacts (PDF) – Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. 
Contactos Preferidos