Patient Registration Forms & Privacy Notices
If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.
- Patient Registration and Consent
- Registro de Pacientes y Consentimiento para Tratar
- Medical Records Release
- Patient HIPAA Acknowledgement and Consent
Mary Alice Cowan, MD
- Patient Registration
- New Patient Health Questionnaire
- Established Patient Health Questionnaire
- Consent for Treatment and Payment Agreement
Leslie Cohan, MD
Theresa Robinson, MD
James McBride, MD, FACOG
Chundar Tsai, MD
Patient Rights & Responsibilities
We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.
This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.