You must use Firefox or Google Chrome as Explorer is not supported.
It is important to fill out the form in its entirety. If there is missing information, it increases your wait time. Thank you in advance.
Please be sure to sign the last page with your mouse and click submit. Please do not print documents, click on the words "CLICK HERE".
If you are using an IPAD or IPHONE, please open in PDF not in Word . ANDROIDS devices are not supported. Please have your paperwork done the day before your appointment. If you are having problems completing the forms please call us as soon as possible.
Click Here this will take you to a secure web-page where you can complete your paperwork. Remember to include your health insurance information on the form. Traditional Medicare (red white blue cards) you do not need to include this information we will get a copy of your cards when you arrive.