Forms

Depending on your sex, age and who you are seeing in our practice, please fill out the forms as listed below.

Remember that you need to be at our office 15 minutes prior to your scheduled appointment time to register if you are new to our office. Please bring your insurance card with you. If you have a co-pay or payment due, this will be collected prior to your visit.

New Patient Child ages 2-12

**If someone other than the parent/guardian will bring the child to the office, you will need to complete the Consent for Authorization for Treatment of a Minor naming that person as the parents’ representative.

New Patient Adolescent ages 13-17

**If you come to the office without a parent/guardian, you will need to have your parent/guardian complete and sign the Consent to Treat a Minor form

**If you come to the office with an adult other than your parent/guardian, you will need to have your parent/guardian complete the Consent for Authorization for Treatment of a Minor

New Patient Female seeing Dr. England for Gynecology

New Patient Adult 18 to 64

New Patient Adult 65 and older

Misc Forms

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