If you are a new patient or have not been to the office within the past 12 months, complete the appropriate digital FORM below prior to your visit. If you must print them, email to firstname.lastname@example.org or, if scheduled for an IN OFFICE VISIT, bring the day of your appointment. Be sure we have your current insurance card, photo ID and valid referral (if required by your insurance) in advance of the appointment. Arrive to the office or log into the virtual waiting room 5 minutes prior to your appointment.
Returning Medical Patient Form Update
We reserve an appointment just for you. While most patients are able to arrive on time and keep their appointments, we ask that if you must cancel or reschedule, you do so 24 hours prior to your scheduled visit. In order to maintain a smooth patient flow and accommodate all patients, there is a $50 cancellation fee for medical/surgical/virtual visits or a $200 cancellation fee for cosmetic treatment visits automatically billed to patients who cancel/reschedule less than 24 hours in advance or fail to keep their appointment. Late arriving patient might be asked to reschedule, fees apply.
Parental Consent for Treatment of a Minor
You may also familiarize yourself with the HIPAA Notice of Privacy Practices
Please see the Appointments page for more details.