New Patient Form

Once we have scheduled a first appointment, please fill out this form and email or fax it to me at least 24 hours before our appointment.  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.  My email is secure and encrypted:

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

PDFs can also be signed for free by uploading at: