Patient Forms

We are passionate about what we do.

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment. 


Authorization and Consent for Treatment

All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.

Notice of Privacy Practices

Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

Pediatric Safety & Risk Questionnaire

Click on the form below that matches the age of your child. Please fill out the form and bring it with you to your appointment.

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