New Patient Information:

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Primary care new patient forms

Please download, fill them out, and bring them with you to your visit (if you don't, not to worry, we have them at the office too)



1.) New patient membership agreement:

https://drive.google.com/open?id=1RFyL3Nn8HxAdDP8IJtW6ZAb3BaTKb63b


2.) Recurring payment form:

https://drive.google.com/open?id=1KNFdFG_4bfr4VPf-6jlLMJCmGMqw6Rkn


3.) Private Medical Services to a Medicare member (only download and fill out if you are enrolled in Medicare):

https://drive.google.com/open?id=1RyZSdemfRZShAwZbbOQbCtutCvGoWwbc

Download

Medical cannabis new patient forms

Please download, fill it out, and bring it with you to your visit.


1.) Medical Cannabis intake form:

https://drive.google.com/open?id=1WJ7Wz2_KL-q8O-vbl1ogw6sW6b2CbE4i


2.) HIPAA Privacy authorization form:

https://drive.google.com/open?id=1f6qtbJj31xuUKjif41qnnPFMJq793xgM


3.) Medical Cannabis consent form (I will explain it to you in person at your visit):

https://drive.google.com/open?id=1H5svANa3GAjBC5XlD--DHq-sjJyNJ4jL

Download