Thank you for your interest in becoming a new patient in our practice! We are currently closed to new patients until July 1, 2018. However, if we are listed as the PCP (Primary Care Physician) on your health insurance ID card, we are happy to enroll you as a new patient during this time.
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 please fax or drop off the following forms to the office, prior to calling to schedule an appointment. Once we have received your new patient paperwork, we will contact you to schedule your first appointment.
PLEASE NOTE: We are not providers for MEDICAID.
- Patient Information and Consent Form
- 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.