Please download and fill-out our Patient Registration Form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the US Congress in 1996. Title II of HIPAA, known as the Administrative Simplification provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers. It helps people keep their information private.
We take the privacy of our patient’s information seriously. Below you will find a copy of our privacy practices for your review as well as an acknowledgement that you will need to sign prior to treatment.
You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.