NEW PATIENT PACKET

DIRECTIONS:

1. Read our "Privacy Notice"

2. Print the "Health History Form" (2 pages) and complete it in ink.

3. Print the "Patient Routing Form" and complete it in ink.

4. Bring completed forms with you to the Health Center.

HEALTH HISTORY - Page 1

HEALTH HISTORY - Page 2

PATIENT ROUTING FORM

PRIVACY NOTICE