Patients wishing to establish with one of our providers should complete this form and follow the return instructions included in the form.

Patients who are coming for a Medicare Wellness Exam should complete this form and bring it with them to their appointment.

Patients who are coming for an ultrasound should review this form in advance, as certain exams require specific preparations.

Autorización De HIPAA Para Divulgar Información Del Paciente

Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Autorización y Consentimiento Para el Tratamiento

All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.

Contactos Preferidos

Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.

This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Política Financiera (PDF)

This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Aviso de prácticas de privacidad

Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.