Patient Registration Forms Medical Records Request & Authorization
New to our Clinic?  If you would like to expedite your wait time, you may download our patient registration forms here and fill them out prior to your appointment date and time!

Adult Patients – Please complete each form below

Patient Registration Form (ENGLISH  /  ESPAÑOL)

Health History Form (ENGLISH  /  ESPAÑOL)

Advance Directive Information (ENGLISH  / ESPAÑOL)

Patient Privacy Rights (ENGLISH /  ESPAÑOL)

Pediatric Patients (up to age 18) – Please complete each form below

Patient Registration Form (ENGLISH   /  ESPAÑOL)

VFC Eligibility Screening (ENGLISH  /  ESPAÑOL)

TB Questionnaire
 
Dental Patients – Please complete each form below

Patient Registration Form (ENGLISH  /  ESPAÑOL)

Dental History Questionnaire (ENGLISH  /  ESPAÑOL)

Oral Health Risk Assessment (ENGLISH /  ESPAÑOL)