For you convenience, you may complete these forms prior to your visit by accessing them at the link below. Bring the completed forms with you to your appointment. Please print the forms and complete by hand.

*Please note, the questions we ask on the form will provide our staff with essential data on your health and medical history. You will also be asked questions concerning your contact information, insurance and billing information.

There may be times when we will need to contact you, so please provide as complete information as possible, including a cell number and email address.

We will ask to see your driver’s license on every visit and will scan your information into our system as needed to keep your information current.

Before coming to a clinic location for your first visit, the following form should be completed.

Request an Appointment

Hours of Operation: Mon – Fri 9 am to 5 pm

561-330-4695

561-703-6936

Emergency Contact Phone Number

Call or complete the form below to request an appointment, and one of our patient coordinators will be in touch with you shortly.