Patient Registration
If you are interested in scheduling a New Patient Consultation, please complete our New Patient Registration forms.
Once the New Patient Registration form is completed a member of our team will contact you to schedule your first appointment with us.
PLEASE NOTE: The New Patient Registration must be completed in full including all patient demographic information, insurance and policy holder information, the health history, and the appointment agreement.
After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Patients with HUMANA or AMERITAS please call the office and speak with a member of our billing team to discuss claim submission and billing options as we are considered an out-of-network provider.
Note to Patient: Upon filling out your first name, last name, email and at least one phone number field (a valid home or cell phone) a button will appear in the upper right corner titled “Save and Exit” . This button allows you to save and exit your form to complete at a later date. The system will send a registration email to the email provided on the form, so that you may setup a login to go back and finalize your registration form online.