Patient Registration Forms & Privacy Notices
If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.
- Patient Registration and Consent
- Registro de Pacientes y Consentimiento para Tratar
- Medical Records Release
- Patient HIPAA Acknowledgement and Consent
- Formulario de HIPAA Consentimiento
- Health History - Dr. Leon Monzell & Marcus
- Health History - Dr. Katz
- Katz Follow Up Form
- Historia de Salud - Leon and Olowe
- Financial Policy
- Patient Financial Consent
- Consentimiento Financiero del Paciente
- Lista De Medicamentos
- First Point of Contact
Patient Rights & Responsibilities
We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.
This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.