Forms

To save time, please print out the following forms and bring them to your first appointment:

New Patient Registration Form

Intake and History Form
This form authorizes Clear Choice to request medical records from your previous providers.

If you have important medical history or a history of skin cancer, please provide your attending provider's information.

Medical Records Request

This notice is for your information and is optional to print:

HIPAA Privacy Notice

Para ahorrar tiempo, imprime y llene la forma y tráigala a su primera cita:

Forma para nuevos pacientes

Historia y Formulario de Admisión

Este aviso es para su información y es opcional para imprimir:

Aviso de HIPAA de prácticas de privacidad