Your information will be securely sent to our server and imported into your patient chart. 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 upload).
  • Signatures will be recorded digitally at our office.

If you would like to transfer your records or x-rays from another office, please fill out the form below, give it to the previous office, and have them fax or email us the information. We may not need to retake x-rays if we are able to receive current ones from another office. Please do this before your appointment so that we can have your information ready for your appointment.