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Patient Forms

In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

Adult Patient Forms

Adult Patient Forms

15 & Under Patient Forms

15 and Under Forms

 

Welcome Form New Patient
15 & Under Form: Welcome Form New Patient
15 & Under Form: Entrance Symptom Checklist
Optomap Agreement Form
Consent to Disclose Medical and Payment Information
Notice of Privacy Practice (HIPAA)
15 & Under Form: Notice of Privacy Practice (HIPAA)
15 & Under Welcome Forms for Soonercare Patients
Optomap Agreement Spanish Form
Consentimiento para divulgar informacion medica y de pago
Today's Visit

Learning Resources for Patients

Advance Dental Care
(comprehensive dental care, emergency dentistry)

Daniel Craviotto MD
(orthopedic surgery, sports medicine, and joint replacement solutions)

Carolina Sports Medicine
(sports injury and orthopedic care)

Breathe America
(advanced respiratory care, allergy treatments, and pulmonary solutions for all ages)

True Skin Care Center
(medical acne treatment, isotretinoin therapy, and personalized dermatologic solutions)

Grundy County Health Department
(public health and wellness services)

Anderson Chiropractic & Wellness
(chiropractic and wellness care)

Dr. Kat's Clinic
(personalized medical care)

White Mountain Dental
(dental services in Rock Springs, Wyoming)

Kling Dermatology
(advanced dermatology practice specializing in acne, rosacea, eczema, psoriasis, and complex skin disorders, with a focus on individualized care and modern aesthetic treatments)

Green Valley Chiropractic
(chiropractic services)

Florida Wellness Institute
(holistic health services, chiropractic care, and integrative medicine therapies)

Westford Internal Medicine
(primary care services, telemedicine consultations, and chronic condition management)

Genesis Dental Care
(dental services for all ages)

Healthy Lungs
(comprehensive pulmonary care, asthma and COPD management, and respiratory diagnostics)

Central Florida Health Care
(medical center providing primary and preventive healthcare services, including family medicine, pediatrics, dermatology, dentistry, urology, pharmaceutical services, and other comprehensive health programs)

NY SportsMed & Physical Therapy
(comprehensive orthopaedic and sports-medicine care, pain relief and performance recovery, joint replacement surgery, non-operative rehabilitation and athlete support services)

Duchesne Clinic
(health services for underserved populations)

Hillbrook Dental
(comprehensive dental services)

Didriksen Dental
(comprehensive dentistry offering professional treatment methods with modern pain-management options)

Saint Vincent Clinic
(healthcare for the uninsured)

Millbrae Hospital
(professional healthcare services)

The Center for Health and Wellbeing
(comprehensive medical services, integrative care, holistic treatments, and personalized wellness solutions for families)

Umbrella Clinic
(comprehensive health services)

ANB Wellness Center
(alternative health and wellness)

EnteBella Medical
(acne and skin treatment, weight management, pain management, regenerative therapies, and broad wellness care)

Collingham Dental Clinic
(family dental services)

Beach Health Clinic
(community-based primary care, preventive screenings, men’s health, chronic disease management, and affordable medical assistance)

ABH Pharma
(custom supplement manufacturing, private label solutions, and nutraceutical development)

Northside Family Dental Care
(family dental care)

Weston Dental Care
(comprehensive dental services)

CTH Healthcare
(community healthcare services)

P2RX
(public health information resources)

Oro Surgery
(oral and maxillofacial surgery)

Northtowns Orthopedics
(specialized orthopedic care, sports medicine, joint replacement surgery, fracture management, and rehabilitation services)

George Dermatology
(comprehensive dermatology care, acne treatment, and cosmetic skin solutions)

Mental Health America of Central Carolinas
(mental health support and resources)

Capella Healthcare
(comprehensive healthcare management)

Care Pharmacy
(local pharmacy services)

Tampa Chiropractic & Wellness Center
(holistic chiropractic care)

Palm Desert Implant Dentist
(dental implants and restorative dentistry)

Walsh Wellness Center
(holistic health services)

Dr. Bill's Clinic
(personalized healthcare)

DrX Medical Clinic
(medical services and care)

Precision Dental
(general dentistry services)

Surgery Information Center
(surgical procedures and information)

Columbia Urological Associates
(advanced urologic care, erectile dysfunction (ED) treatment, minimally invasive surgery, and urinary disorder management)

Fountain Grove Dental
(family dental care)

ProLife Healthcare
(family-oriented healthcare services)

Advanced Family Care
(comprehensive care services, vision exams, and eyewear solutions for all ages)

All Valley Home Care
(home healthcare services)

Cancer Research UK Centre Glasgow
(cancer research and support)

Montgomery County Health Department
(public health and prevention programs)

Mental Health America of Southeastern Arizona
(mental health resources)

El Camino Surgery Center
(surgical care and outpatient services)

Doctor Steve's Clinic
(holistic medical care)

Davis Oral Surgery Center
(oral surgery and dental implants)

AmeriDental Group
(affordable dental care)

Center for Endocrine Care
(thyroid and hormone disorder treatment, diabetes management, and endocrine diagnostics)

Healthy Kids Dane County
(community health programs for children)

New York Downtown Hospital
(comprehensive healthcare services)

Ash Chiropractic & Wellness
(chiropractic and wellness care)

Online Pharmacy NZ
(trusted online pharmacy offering a wide range of prescription medications, health products, and over-the-counter remedies delivered across New Zealand)

EPA Dental
(dental care and services)

Denver Urology Clinic
(specialized urological practice focusing on erectile dysfunction treatment, men’s health, and advanced management of kidney, bladder, prostate, and reproductive system disorders, offering minimally invasive procedures and personalized care)

Community Health System
(regional health system)

Anberry Hospital
(acute and long-term healthcare)

Washington Healthcare Alliance
(healthcare advocacy and resources)

Melanoma Care
(melanoma treatment and research)

Columbia SC Dentist
(comprehensive dental care)

Northfield Chiropractic
(expert chiropractic services)

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