Patient Forms

Use the links below to submit refill request, dental request or patient intake form online. An intake form must be complete prior to TeleHealth appointments. Please submit refill requests 7 days prior to end of medications.

Patient Intake Form

Fill out this form prior to your first appointment. We provide care on Mondays and Wednesdays from 10 am to 4 pm and on Thursdays from 5 to 8 pm.

Medication Refill Request Form

Please submit refill requests 7 days prior to the end of medications.

Dental Care Request Form

Fill this form out prior to your first dental visit to request services.