Patient Forms


Patient Forms

If you're a new patient, please complete the following forms and bring them to our office with a copy of your photo ID and insurance card(s), front and back. Once your information is verified, we will notify you to schedule your appointment.

New Patient Registrations Requirements

New patient form

If you would like our team to coordinate care with another physician practice please complete the form below to authorize the release of your medical record or the authorization for another physician practice to disclose information to us:

Medical Record

Release of medical record information

Disclose Information

Authorization to disclose

information form


HIPPA authorization form

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

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For the entire state OF Oklahoma

We accept insurance for telemedicine!

 For cash paying patients it will be $140 for new patients and $115 for follow up appointments.

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