Patient Paperwork

When you make an appointment through our website you will be sent an invitation to set up a patient portal through our electronic health records system Charm. Once you have set up your account you will see new patient paperwork in the questionnaires tab (you will also receive an email alerting you of questionnaires to fill out). Please fill out the requested questionnaires prior to your appointment. You may also get a text message from our billing department to get a picture/ copy of your insurance card. If we do not reach out for this prior to your visit we will ask for your card at your visit to make a copy for your chart. 

List of Patient Forms: 

New Patient Intake Form (Adult): https://hipaa.jotform.com/212318361039046

New Patient Intake Form (Pediatric): https://hipaa.jotform.com/213247145493153

Adult Preventative Visit Paperwork: https://hipaa.jotform.com/212318444967058

Link to Upload your Insurance Card to Us: https://hipaa.jotform.com/212334304434040

Informed Consent and Release: https://hipaa.jotform.com/212334349124045

Copy of Clinic Policy: https://hipaa.jotform.com/212333713964051

Copy of HIPAA Notice: https://hipaa.jotform.com/212334394051044

Form to Update your Preferred Pharmacy: https://hipaa.jotform.com/212334284911148

Records Release to our clinic: https://hipaa.jotform.com/212334850363148

Records Release from our clinic: https://hipaa.jotform.com/212334619239052