The most convenient and secure way to fill out and sign all 3 forms is to go to your Patient Portal by clicking on the green button below. Please see the instructions below.
If you have not signed into the Patient Portal yet or if you have forgotten your password, please call our front staff during office hours.
For easy to follow instructions, choose one of the following.
How to Upload Files To Share With Clinic
Please visit our clinic in person to fill out the forms if you are having difficulty with the instructions or unable to update your information.
If you are having trouble filling out and signing the forms online, you can also download the forms by clicking on the links below. Please print, fill out and fax to 833-606-1557 or mail or email to email@example.com or firstname.lastname@example.org
Our Cancellation Policy
We ask that you respect and value our provider’s professional time.
- Please arrive at least 20 minutes before your appointment.
- No-show or failure to cancel your appointment at least 48 business hours in advance will incur a $45 fee.
- Two violations of this cancellation policy without adequate reason will trigger a 30-day discharge process to end our patient-physician relationship.