For your appointment,  please bring:

 

(1) a completed health history form      (2) a signed office financial policy 

 

We have included the forms in Spanish for the benefit of those who feel more confortable speaking and reading in Spanish. 

Si tiene algún problema llenando los formatos en inglés, por favor utilize y complete los formatos en español antes de llegar a su cita.

 

Forms English

 

Adult Health History Form (English)

(ages 13 and older)

 

Child Health History Form (English)

(ages 12 and younger)

 

Office Financial Policy (English)

 

 

Forms in Spanish

 

Adult Health History Form (Spanish)

(edad 13 o mayor)

 

Child Health History Form (Spanish)

(edad 13 o menor)

 

Office Financial Policy (Spanish)

 

 

Other/Otros

 

HIPAA Notice