New Patient Forms (Electronic Option)

We welcome you to our practice and we look forward to providing the best service to you and your family.

What to do before your first visit:

  • Visit our Billing/Insurance page, under Resources, to verify that we accept your insurance.
  • Call your insurance carrier and change your child’s primary care physician to one of our providers.
  • Request your child’s Medical & Immunization Records from your previous physician. You can use our Records Release From Previous Practice. Fill out this form and fax it to your previous practice to request your child’s records.
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  • Read our Notice of Privacy Practices Form.
  • Fill all forms below prior to your visit:

    Please Read: We use a third party service that allows for these forms to be sent to us electronically in a secure manner. This service is fully HIPAA compliant and is mainly used for signing forms on-line, which is the reason these links will refer to each form as “a signed document”, even though they may not require a signature. Once you’ve completed a form, you won’t be able to return back to this page by using the back arrow. To save you time, please copy http://bit.ly/rpanewpatientforms to paste into your browser once you finish each form.

    Note: If you would rather fill these forms on paper, print them and fax them us, plese go to: New Patient Forms (Paper Option).

    - New Patient Form (Fill One Per Patient)

    - Authorization Acknowledgement Form (Fill One Per Patient)

    - Family History (Fill One Per Family)

    - Past Medical History (Fill One Per Patient)

    • Once we receive a copy of your records and these forms are completed, we will contact you to schedule an appointment.
    • Remember to bring your child’s insurance card so that we can scan it for our records.
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