Welcome to the secure new-patient registration form. Please use the following instructions to help in filling out the form:
- Please complete all fields highlighted in green; other fields are optional (note: 'Client' is the patient).
- If you will be using insurance, please check the 'Insurance' box (in middle of form).
- If you prefer to pay out-of-pocket and will not use insurance, please check the 'Self Pay' box.
- When finished, click 'Save'