Please print and complete ALL FORMS below to submit at the time of your visit. These forms are in PDF format and can be easily printed. If you are unable to print these forms, you may receive them at the time of your visit. However, we do request an early arrival before your appointment to allow ample time for completion of necessary forms. Thank you in advance.
New Patient Information Form: Your contact and insurance information.
New Patient Medical History Form: Your medical history including medications, medical problems, and prior surgeries.
Health Information Portability and Accountability Act (HIPAA):
We understand the importance of maintaining our patients' privacy and protecting their medical information. The Health Information Portability and Accountability Act (HIPAA) became effective on April 14, 2003. The regulations specifically outline various protocols regarding the handling of a patient’s medical information and detail the requirement for all healthcare providers to notify patients of how their medical information could be used and/or disclosed. To comply with these regulations we have developed our Notice of Privacy Practices. If you have any questions regarding this Notice or our Privacy Practices in general, please feel free to call our Privacy Officer at (210) 259-8155. Attached below is a copy of our Notice of Privacy Practices for your review which can be printed for your own records.