NEW PATIENT FORM

Click the button below and it will redirect you to a new webpage to fill out our NEW patient form.

TIPS:

• Make sure you have photos of your ID and Insurance (Front/Back) already sitting on your computer desktop so that you can upload them into the form.

• Only complete this form on a computer, not phone, as phones refresh and you may lose all of your typed data.

• Once you submit the form, the biller will IMMEDIATELY start working in verifying your insurance, please give your insurance up to 2 weeks to let us know if you are approved. We will text your cell at that point.

You can also text our main office number to let us know that all is submitted or if any questions:

Text (not call or voicemail) to 562-947-8832 for quickest response