Registration Forms
If you have already scheduled an appointment, you may download and print our registration materials by clicking the appropriate link below.
New Patient (Adult)
New Patient (Minor)
Medicare Patient
If you are unable to print the forms, please call us.
We will be happy to mail copies to you.
New! Telemedicine Consent Form
IMPORTANT: Completion of these forms in advance and arriving 15 minutes prior to your scheduled appointment time will speed your check-in process and will ensure that your visit runs smoothly.
Please have your forms completed before you arrive. If you wait until the time of your visit to complete your forms we will not be able to see you on time.
Our Privacy Practices (HIPAA information)
For a copy of our Office's Privacy Practice Notice, CLICK HERE
Is the Patient a Minor?
Patients under the age of 18 MUST be accompanied by a parent or legal guardian ON EVERY VISIT. Minor patients that arrive unaccompanied will not be seen and will need to reschedule when a parent is available.
Do you use the Medco or ExpressScripts prescription programs?
If so, please bring your fax/mail order form with you to your appointment so that we may get your prescriptions ordered as quickly as possible.
Insurance
Download: List of insurance companies we participate with
Map
Download: Color map of the GBMC Campus
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