Patient Registration

Patient Forms

For your convenience prior to your appointment, please click on the button(s) below to complete and submit the patient form(s) online before your visit.

Online Patient Registration Form

Who will be responsible for your account?

  • A guarantor is the person held responsible for the patient’s financial account.
  • The guarantor is ALWAYS the patient unless the patient is a MINOR (under age 18) or an incapacitated adult.
  • The guarantor for a minor child is the parent or legal guardian that signs the CONSENT FOR SURGERY form and the PATIENT HEALTH HISTORY form.
  • STUDENTS age 18 or older are their OWN guarantor.
  • The GUARANTOR is NOT automatically the insurance subscriber or head of household.
  • The “other parent” is NOT the guarantor. If the parent or legal guardian presenting the child brings a divorce decree stating the other parent is 100% financially responsible for the child’s medical bills, the guarantor will be changed to the parent designated in the divorce decree.
  • Your spouse can be your guarantor ONLY if you are an incapacitated adult.