This form does not require any input but provides you with the information necessary to indicate what HIPAA compliance is and the steps we take to ensure that we stay in compliance. You should read this document in its entirety so that you are aware of your rights under HIPAA.

If you would prefer not to submit your new patient information electronically through the site, please download, print and either mail or bring this form into any one of our offices. We will get the paperwork started and get you setup in our system and hopefully your first appointment.