24 HOUR EMERGENCY SERVICE IS AVAILABLE FOR TREATMENT IN THE FACILITY.
(FEES APPLY)

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ONLINE INTAKE FORMS
1-please fill out and sign all 4 forms for your convenience
2-you can fax or email once you have signed all forms.
Soon you will be able to directly transfer all forms online

English

MEDICAL HISTORY

PATIENT INFORMATION

PATIENT INFORMED CONSENT

PRIVACY FORM

1-follow the above instructions with these three forms

Spanish
MEDICAL HISTORY

PATIENT INFORMATION

PATIENT INFORMED CONSENT
PRIVACY FORM