FORMS & NOTICES

PLEASE REVIEW THE FOLLOWING FORMS AT YOUR CONVENIENCE. 

YOU MAY COMPLETE THOSE FORMS REQUIRING INFORMATION TO BE FILLED OUT AND BRING THEM TO YOUR VISIT. ALSO, REMEMBER TO COMPLETE A NEW DEMOGRAPHICS FORM ANYTIME YOUR PERSONAL INFORMATION CHANGES. 

YOU CAN VIEW, DOWNLOAD AND/OR PRINT THE FORMS BY CLICKING ON THE LINKS BELOW.
SelectionFile type iconFile nameDescriptionSizeRevisionTimeUser
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Patient Medical History-PDF format  220k v. 1 Aug 31, 2016, 10:18 AM ARLENE GARCIA
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PRIVACY NOTICE FOR PROTECTED HEALTH INFORMATION  36k v. 2 Jul 9, 2013, 11:26 AM ARLENE GARCIA
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Patient Information-Demographics-PDF Format   247k v. 1 Aug 31, 2016, 11:27 AM ARLENE GARCIA
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Patient Information-Demographics Word-Format  14k v. 1 May 24, 2016, 4:25 PM ARLENE GARCIA
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Release of Medical Records.PDF format download  162k v. 1 Aug 31, 2016, 11:29 AM ARLENE GARCIA
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Release of medical Information  Aug 31, 2016, 11:21 AM ARLENE GARCIA
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