Fill out your paperwork at home!
New Patient Intake Form
Medical Record Release Authorization
If you have seen another physician within the last 12 months, please complete this online medical records release form. We will retrieve your records for you free of charge!
Please note that you will not fill out your name in the first field -- the system will do that for you automatically. After you submit the form, the system will direct you to check your email for a confirmation link. This proves your identity and is the last step in the form process. Once you click on the email confirmation, the form will be sent to us automatically. Our dedicated medical records specialist will contact you as soon as we receive your records from your physician. If you have any questions, just call us at 623-847-6652.