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.

Registration Forms

Established Patients

Prenatal Risk Screening

To be completed if patient is a minor

Medical Record Requests

If you would like to have your medical records sent to us prior to your visit, please complete and sign the form corresponding to the location you will be visiting:

Release of information – Village Blvd office, West Palm Beach
OR
Release of information – Palms West office (next to Palms West Hospital), Loxahatchee

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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.

Patient Rights & Responsibilities

Derechos y Responsabilidades del Paciente

Privacy Notices

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.

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