Forms – New Patient – Release of Information – Eligibility
New Patient Forms
If you are a new patient, you will need to complete the form below before seeing a health care provider. Print and fill out the New Patient Form in the comfort of your home and avoid having to come 30 minutes earlier for your appointment to do paperwork.
An eligibility appointment is very important in order to assess whether or not you qualify for various programs and/or financial aid from the government. Our Eligibility Specialists are highly-trained and will match you with the best options you have so that you will benefit from the most affordable health care solution.
We take our responsibility towards you as a patient very seriously and expect the same in return. Please read the “Patient Contract” to understand our expectations of you and our commitment to you.
Release of Information (ROI) Authorization
Consent for Non-Parent