Consent to Treatment & Financial Agreement
Consent to care, insurance billing authorization, financial responsibility, and required signatures.
Download PDFSave time
Patient Forms
Download, complete, and bring the forms that apply to your visit.
New Patient Medical History
Medications, allergies, conditions, procedures, family history, health habits, and preventive care.
Download PDFHIPAA Notice & Acknowledgment
Review our Notice of Privacy Practices and complete the acknowledgment on the final page.
Download PDFPatient Rights & Office Policies
Patient rights, responsibilities, appointments, communication, after-hours care, and office policies.
Download PDFPatient Registration
Demographics, contact details, emergency contact, pharmacy, and referring provider information.
Download PDFInsurance Information
Primary and additional insurance details. Bring your insurance card and photo ID to your visit.
Download PDFAuthorization to Release Information
Authorize information use and select how the clinic may communicate with you.
Download PDFTrouble downloading a form?
Call us at 401-473-0085 and we will send the forms to you another way.
Forms complete?
Bring them with you to your first appointment, or request a visit now.
Request Appointment