To join my practice, please download and fill out the following forms:

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1. Patient Information

2. HIPAA Consent Form

3. Financial Policy including Credit Card Form

4. Patient Health History

5. Include all Prior Immunization Records (can be requested form your previous Doctor)

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Our Welcome Coordinator, Allie, will be in contact with you once all Enrollment Forms and Prior Immunization have been received.

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With Gratitude and Appreciation,

 

Dr. Roma