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New Patient Form

Once we have scheduled a first appointment, please fill out this form and email or fax it to me at least 2 business days prior to our appointment (for example, if our appointment is for a Monday, return the completed form by the previous Thursday).  I will then send you instructions for our Zoom meeting.  This form must be completely filled out and signed before we can have our appointment.  Our appointment is subject to cancellation if this form is not returned at least 2 business days prior.  My email is secure and encrypted:

NOTE:  PDFs can also be signed online for free at several websites, including:  or


In order to fill out and save the above PDF, you'll need the latest Acrobat Reader.  You can download Acrobat for free here:

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