Click the blue button to download the form.


Patients must bring current photo ID and health insurance cards to every appointment.

Copays are due at time of service.

You only fill out this form and bring to your appointment if you have not been seen by our office in the past year.

Patient Bill of Rights


We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family.  However, when you do not call to cancel an appointment, you may be preventing another patient from getting much needed treatment.  Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit, due to a seemingly "full" appointment book.  If an appointment is not cancelled at least 24 hours in advance you will be charged a twenty five dollar ($25.00) fee; this will not be covered by your insurance company.