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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

Grundy County Health Department - public health and wellness services.

George Dermatology - comprehensive dermatology care, acne treatment, and cosmetic skin solutions.

Surgery Information Center - surgical procedures and information.

Carolina Sports Medicine - sports injury and orthopedic care.

Saint Vincent Clinic - healthcare for the uninsured.

AC Professional Dentistry - modern dental practice providing comprehensive dental care, including preventive services, restorative and cosmetic dentistry, advanced diagnostics, personalized treatment planning, and flexible scheduling focused on long-term oral health and patient comfort.

ABH Pharma - custom supplement manufacturing, private label solutions, and nutraceutical development.

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

Palm Desert Implant Dentist - dental implants and restorative dentistry.

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

ProLife Healthcare - family-oriented healthcare services.

Capella Healthcare - comprehensive healthcare management.

True Skin Care Center - medical acne treatment, isotretinoin therapy, and personalized dermatologic solutions.

Healthy Kids Dane County - community health programs for children.

EnteBella Medical - acne and skin treatment, weight management, pain management, regenerative therapies, and broad wellness care.

Patient to Prescription - telehealth platform offering virtual medical and mental health visits, including diagnosis, treatment, and prescription services where appropriate.

Collingham Dental Clinic - family dental services.

El Camino Surgery Center - surgical care and outpatient services.

Duchesne Clinic - health services for underserved populations.

Doctor Steve's Clinic - holistic medical care.

Florida Wellness Institute - holistic health services, chiropractic care, and integrative medicine therapies.

Columbia SC Dentist - comprehensive dental care.

Northside Family Dental Care - family dental care.

Cancer Research UK Centre Glasgow - cancer research and support.

Precision Dental - general dentistry services.

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.

Care Pharmacy - local pharmacy services.

Westford Internal Medicine - primary care services, telemedicine consultations, and chronic condition management.

Weston Dental Care - comprehensive dental services.

New York Downtown Hospital - comprehensive healthcare services.

Dr. Kat's Clinic - personalized medical care.

All Valley Home Care - home healthcare services.

ANB Wellness Center - alternative health and wellness.

Fountain Grove Dental - family dental care.

Advanced Family Care - comprehensive care services, vision exams, and eyewear solutions for all ages.

Davis Oral Surgery Center - oral surgery and dental implants.

CTH Healthcare - community healthcare services.

EPA Dental - dental care and services.

Northfield Chiropractic - expert chiropractic services.

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

Healthy Lungs - comprehensive pulmonary care, asthma and COPD management, and respiratory diagnostics.

Washington Healthcare Alliance - healthcare advocacy and resources.

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

DrX Medical Clinic - medical services and care.

AmeriDental Group - affordable dental care.

Advance Dental Care - comprehensive dental care, emergency dentistry.

Green Valley Chiropractic - chiropractic 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.

Center for Endocrine Care - thyroid and hormone disorder treatment, diabetes management, and endocrine diagnostics.

Anderson Chiropractic & Wellness - chiropractic and wellness care.

Daniel Craviotto MD - orthopedic surgery, sports medicine, and joint replacement solutions.

Umbrella Clinic - comprehensive health services.

Community Health System - regional health system.

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.

Millbrae Hospital - professional healthcare services.

Riverview Urologic - urology practice providing diagnosis and treatment for urinary tract and male reproductive health conditions.

Mental Health America of Central Carolinas - mental health support and resources.

Genesis Dental Care - dental services for all ages.

Ash Chiropractic & Wellness - chiropractic and wellness care.

Hillbrook Dental - comprehensive dental services.

Mental Health America of Southeastern Arizona - mental health resources.

White Mountain Dental - dental services in Rock Springs, Wyoming.

Walsh Wellness Center - holistic health services.

Breathe America - advanced respiratory care, allergy treatments, and pulmonary solutions for all ages.

Montgomery County Health Department - public health and prevention programs.

Oro Surgery - oral and maxillofacial surgery.

Melanoma Care - melanoma treatment and research.

Columbia Urological Associates - advanced urologic care, erectile dysfunction treatment, minimally invasive surgery, and urinary disorder management.

MedMalRx Health Center - healthcare-focused center offering medical support services, treatment pathways, and healthcare standards.

Tampa Chiropractic & Wellness Center - holistic chiropractic care.

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

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.

Dr. Bill's Clinic - personalized healthcare.

Anberry Hospital - acute and long-term healthcare.

Call Our Two Offices