Please use the link below to fill out your new patient paperwork. This information will be transferred securely to our office for your first appointment. If you cannot load and complete the paperwork ahead of time, please be advised that you will need to fill it out electronically when you arrive for your first appointment.
When making a new patient appointment you will be asked to pay a $100 non-refundable deposit over the phone. This will secure your spot with us and serve as a credit to be applied towards the remaining balance due on the new patient appointment. Should you need to reschedule your appointment, the deposit will go towards the rescheduled visit as long as 24 business hours notice is given. Thank you for your cooperation and understanding.
ProHealth Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, click here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Intake Form
New Patient Information
HIPAA PRIVACY & PAYMENT AGREEMENT FORMS – REQUIRED
Please download, complete and bring the following forms with you to your first appointment. If you cannot download the forms, please plan to arrive at least 15 minutes early so that you can fill out the paperwork in our office.
HIPAA-Consent for Use and Disclosure of Health Information
HIPPA-Notice of Privacy Practices
HIPAA-Acknowledgment of Receipt
Payment Agreement and Cancellation Policy
Depending on your needs, you may be asked to fill out one or more of the following: