We provide our Primary Visit Form online so that you can fill it out in the comfort of your own home and at your convenience. You can download the form and complete it either using your computer or print and complete it by hand. Once completed, you can submit the form on our website using the submission form on this page, or you can print the PDF and bring it with you to our clinic.

Important: To complete the fill-able PDF on your computer, follow these steps:

  1. First DOWNLOAD the PDF to your computer
  2. Open downloaded PDF and fill in all fields
  3. Save completed form
  4. Submit using the “online form submission” on this page

If you would like to download the PDF, and do not already have AdobeReader® installed on your computer, click HERE to download.

Online Form Submission

Your Name (required)

Your Email (required)

Your Phone

1.) Download form to computer/device
2.) Complete form and save completed version
3.) Click "Choose File" below & attach your completed form
4.) Click "Send"