Thank you for your interest in becoming a new patient in our practice!
Our goal is to ensure you are scheduled for the appropriate amount of time with the provider who is best able to assess and address your needs. Therefore, we ask that you pre-register with the office before we schedule any appointments. Our doctors are currently closed to new patients. However, you are welcome to see one of our Physician Assistants, who usually have new patient appointments available within 30 days.
Please fax, mail or drop off the following forms at the office (see the Contact Us tab). Emailing the forms to the office is not a secure format for transmitting personal health information.
You will need to complete and submit items 1-4 below PRIOR to scheduling your first visit to the office.
*We are not providers for Medicaid
New Patient Forms
- Patient Demographics and Consent
- FFM Financial Policy 2020
- Credit Card on File Agreement
- Medical history form
- Medical Records Request TO FFM– especially If you have a complicated medical history
- Copy of insurance card (both sides, please)
Additional Information and Forms
- Notice of privacy practices
- Minor Consent Form
- Office Financial Policy
- Medical Records Request FROM FFM
- Pay your bill online for patients enrolled in our patient portal
Select the form that you find of interest and it will download to your computer or open up within Adobe Acrobat Reader® within your web browser.
If you do not have the Adobe Acrobat Reader® click here to have it installed onto your computer.