Patient Intake Forms

Choose how you'd like to complete your paperwork before your first visit

💾

Download & Fill on Your Computer

Download the PDF, fill it out using a PDF reader (like Adobe Acrobat or Preview), then email it back or bring it to your appointment.

Download PDF Form
🖨️

Print & Fill by Hand

Print the form at home, fill it out by hand, and bring it with you to your first appointment. No computer needed.

Open PDF in New Tab

📋 What You'll Need to Complete the Form

  1. Photo ID — Driver's license or other government-issued identification
  2. Insurance card(s) — Primary and any secondary insurance
  3. Current medications list — Names, doses, and how often you take them
  4. Previous doctor information — Name, address, phone, and fax of your prior physician
  5. Emergency contact — Name, relationship, and phone number
  6. Pharmacy information — Name and location of your preferred pharmacy

🏥 Before Your First Visit

  1. Arrive 15 minutes early to allow time for check-in and any remaining paperwork
  2. Bring your insurance card and photo ID — we need to make copies for your file
  3. Bring your co-payment — co-pays and existing balances are due prior to seeing the doctor
  4. Bring your completed intake form — whether downloaded, printed, or we'll provide one at the office

⚠️ Cancellation Policy

Due to an increase in "no shows," a $25.00 fee will be applied if an appointment is not cancelled within 24 hours.