*Please fill out and send back via email, fax, or mail (if we will receive it before your appointment date).
*You may also drop off or bring your paperwork with you to your appointment.
*If you need us to receive any medical records from another physician you have seen, please fill out this form and send it to us via email, fax, mail, or you can come by the clinic and drop it off.
*Once we receive the form, we will fax it to the designated physician.
*If your child is a patient and they are coming in with someone other than a parent/guardian or they are coming in alone and are still a minor, please fill out this form.
*You can email, fax, or mail (if we will receive it before the appointment date) this form to us or you can have your child bring it with them to the appointment.
*If you are a Provider wanting to refer your patient, please print and fax this form to our office along with office notes, pathology results, and any other kind of information that we may need.