For Medicaid Patients
Medical History (English) – Submit Online
Medical History (Spanish) – Submit Online
Initial Consent (English) – Submit Online
Initial Consent (Spanish) – Submit Online
Patients from 0-3 years – FDH (English) – Submit Online
Patients from 0-3 years – FDH (Spanish) – Submit Online
Medicaid PCP Changes (English) – Submit Online
Medicaid PCP Changes (Spanish) – Submit Online
New Medicaid Patients
Medical History (English) – Submit Online
Medical History (Spanish) – Submit Online
Initial Consent (English) – Submit Online
Initial Consent (Spanish) – Submit Online
HIPPA Policy Acknowledgement (English) – Submit Online
HIPPA Policy Acknowledgement (Spanish) – Submit Online
Patients from 0-3 years – FDH (English) – Submit Online
Patients from 0-3 years – FDH (Spanish) – Submit Online
Private Insurance Patients
Medical History (English) – Submit Online
Medical History (Spanish) – Submit Online
Initial Consent (English) – Submit Online
Initial Consent (Spanish) – Submit Online
Payment Policy (English) – Submit Online
Payment Policy (Spanish) – Submit Online
HIPPA Policy Acknowledgement (English) – Submit Online
HIPPA Policy Acknowledgement (Spanish) – Submit Online