Patient Forms

To reduce your time spent in the waiting room, please print and complete the appropriate forms below prior to your appointment. If you have any questions regarding the completion of your forms, our friendly and helpful staff will be more than happy to assist you upon your arrival.

Interpretation and translation services are available at no cost to you. Please let us know if you need help in a language other than English.

Patient Registration Form

English
Spanish

Sliding Scale Application

English
Spanish
Russian

Notice of Privacy Practices

English
Spanish (to come)

Release of Information

English
Spanish

Authorization for Disclosures

English
Spanish (to come)

Sliding Scale | Proof of Income Info Sheet

English
Spanish
Russian

Sliding Scale | No Income Self Declaration Form

English
Spanish
Russian