Patient Registration
Contact information, emergency contact, insurance details, and referring clinician information.
Forms
Prepare your information before your appointment.
Patient forms help us understand your medical history, current concerns, and goals. Contact our office for the forms needed for your visit and the approved method for returning them.
More forms are coming soon. Please call our office if you need a form that is not yet listed.
Medical History
Current symptoms, medical and surgical history, family history, allergies, and previous treatment.
Medication and Supplement List
Prescription and nonprescription medicines, doses, vitamins, and supplements.
Weight management intake
Your experience helps shape the plan.
For weight management visits, a separate intake helps us understand your weight history, previous approaches, eating patterns, activity, sleep, barriers, and personal goals.
Please complete it as accurately as you can. This information helps guide an individualized plan.Explore medical weight managementConsent, records & communication
Know what each document is designed to cover.
Some forms establish consent and practice expectations. Others help coordinate records and how the office communicates with you.
Consent and practice information
Consent to Treatment
Information about consent for evaluation and care.
Privacy Information
Our Notice of Privacy Practices and any related acknowledgment.
Financial and Appointment Policies
Information about payment responsibilities and appointment expectations.
Records and communication
Medical Records Request or Release
Instructions for obtaining a copy of your records or arranging an authorized transfer.
View records informationCommunication Preferences
Information about how you prefer to be contacted and who may be involved in discussions about your care.
Completing your forms
Clear, complete information avoids unnecessary delays.
Please use your legal name and date of birth, complete the relevant sections, and sign and date forms where requested. If a question does not apply, indicate that rather than leaving it unclear.
If you cannot complete forms before your appointment, call our office for help. Bring any completed paper forms with you unless instructed otherwise.
- ✓Use your legal name and date of birth
- ✓Complete every relevant section
- ✓Sign and date forms where requested
- ✓Mark questions that do not apply
- ✓Bring completed paper forms unless told otherwise
Returning sensitive information
Use only the submission method provided by our office.
Please do not send completed medical forms through a general website contact form or ordinary referral email without arranging a secure method.
Call 844-363-6638 · 844-ENDOMET for assistance.