Please complete and submit these HIPPA compliant forms prior to your child/children’s well visit each year
Wavier for Vision Testing (Ages 1 and 2) (Does not apply to patients with Husky insurance)
Wavier for Hearing and Vision testing (Ages 3 and older) (Does not apply to patients with Husky insurance)
Teen Discussion/CHADIS waiver (Ages 13-17)
Acknowledgement of Financial Policy.
Click here to review Financial policy
Acknowledgement of Receipt of Notice of Privacy Practices
Click here to review Notice of Privacy Practices
Upload a copy of your insurance card
Complete this form if you need to update any demographic or insurance information (eg. address, email address, insurance information)
Waiver to speak to parents/guardians of patients 18y and older
Waiver for portal access for parents/guardians of patients 18y and older