Your information will be securely sent to our server and imported into your patient chart. You do not need to print anything! In order to make sure everything is filed under your name, it is very important that the information is accurate. Please read the following to make sure you successfully submit your information:
Forms are best viewed on a computer or standard tablet. The full page is not visible on smartphones & smaller devices.
Please put your full legal first and last name. Put nickname in the “Preferred” section.
DOB should be in 01/01/2001 format.
Include a unit number if you live in an apartment.
Double-check all numbers and spelling.
The last 4 forms are consents and acknowledgements. Please take time to review them and let us know if you have any questions.
You may review the complete HIPAA Privacy Notice here.
After submitting, please wait until you see a confirmation page (it may take up to a minute to load).