Hospital Affiliation

Patient Registration Forms & Privacy Notices

If you are a new patient, please fill out the registration forms below and bring them with you when you come for your appointment.

Registration Forms

Patient Registration Form

Forma de Registro para Pacientes

Patient Consent Form

Forma de Consentimiento del Paciente

Medical Records Release (as needed)

Autorizacion para Entregar Informacion

Patient Information Form

Forma de Informacion del Paciente

Financial Policy Forms

Financial Policy Form

Poliza Financiera

Privacy Notices

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices

Este aviso describe la forma en que puede utilizarse y revelarse la información sobre su salud y la manera en que usted puede tener acceso a esta información

Aviso Sobre Las Practicas De Privacidad

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