Are you new to our clinic? We want to know a little bit more about you!

Please complete your form to the best of your ability.
We ask you that you bring a copy* with you to your first appointment with us.

* If you’d like to fill out your form on a computer, please use the following instructions:
Click on the appropriate form. It will open in a new browser.
Download the form to your computer.
Fill in the form using Adobe Acrobat.
Save and print the form at home and bring in with you to the clinic.

Need a receipt for your insurance/HSA?

While we are not able to bill your insurance for visits to the Community
Clinic, you may use this receipt for services to submit for reimbursement. Patients receiving One on One that are out-of-network or not having us bill their insurance may also use this receipt.