Forms for NEW Patients

NEW PATIENTS must sign the following documents prior to their first appointment.  Please click on the link to electronically sign the appropriate documents.

  • New patient letter – mandatory for all new patients, It explains our services, company rules, consent to treat, etc.  Please read over it carefully as we do expect all patients to understand and agree to the terms.
  • Medicare private contract – mandatory for all patients above 65 years old or if you have Medicare for any reason.  We are legally not allowed to see Medicare patients if you do not sign this form.  If you are Medicare-eligible but do not have Medicare, you are still required to sign.  This is a federal regulation, not our rule.
  • HIPAA privacy policy – all new patients.
  • Medical records release – optional, for us to receive a copy of your previous records, Please complete the form, save or print it, and send to your PCP,  endocrinologist, and/or surgeon.
  • When granted access, log on to your Patient Portal to update medications, allergies, and your medical history.
  • Please also upload the following documents to your Portal or below:

    1. Copy of your driver’s license (This is mandatory to ensure you are who you say you are and to verify you’re in a state that we’re licensed).  If you don’t have a driver’s license, then upload any photo ID and proof of current address (electric bill, etc).  For minors, a parent or guardian driver’s license is sufficient.
    2. Copy of your insurance card (This is optional, but helpful for prescriptions, labs, etc.). 

Forms for FOLLOW-UP Patients

ESTABLISHED / FOLLOW-UP PATIENTS must sign the following documents.

  • Log on to your Patient Portal before every visit to update medications, allergies, and any changes to your medical history.
  • Medicare private contract – must be signed yearly (applicable only if you have Medicare and/or are 65+ years old)
  • HIPAA privacy policy – should be signed by all patients every 2-3 years.
  • If there have been any changes, please upload the following documents:

    1. Copy of your driver’s license or government-issued ID
    2. Copy of your insurance card(s) (front & back)