New Patient Information:

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Primary care new patient forms


If you are seeing us for direct primary care, these are the forms you need.



1.) New patient membership agreement:

https://drive.google.com/open?id=1f3mSc2NcmTN-MOad5wGHNIfwzh6nTsiV


2.) Recurring payment form:

https://drive.google.com/open?id=1QV6Rbh1LHt52a-3h4UYr2-lwV_sC_itm


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

If you are seeing us for medical cannabis, these are the forms you need.


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