HomeDr. TsoiDr. ChapmanDr. BoustredProceduresContact UsFrequently Asked QuestionsRegistration FormsSurgery FeesFINANCIAL AND INSURANCE INFORMATION

We've updated our forms to make it easier on you! You can now fill out the forms on your computer prior to printing them out. Don't have time for all that? No problem, just scroll to the bottom of the form page (after you click on the form link) and hit the print button.

Registration Forms
To be printed once appointment is scheduled.
WELCOME  to our practice.  We have enclosed our patient forms to eliminate the necessity of arriving early and to give you the opportunity of filling out papers at your convenience.   DO NOT MAIL THESE BACK TO US.
 
Please Print the Forms below and complete the registration forms carefully, including our Credit & Payment Policy. Sign the three “signature” lines.   Payment is expected at the time of your visit, unless you meet the exceptions noted in the policy.  Bring your forms with you to your scheduled appointment.
 
Bring your insurance ID card.  If your insurance plan requires referrals by your family physician to any specialist,  please obtain this referral slip.
 
If you cannot keep your appointment, please arrange to reschedule as a courtesy to others. PLEASE REMEMBER WE TRY OUR BEST TO SEE YOU AT YOUR APPOINTED TIME.  IF THE DOCTOR IS DELAYED BY AN EMERGENCY OR  BY  A PATIENT WHO NEEDS EXTRA TIME, WE WILL INFORM YOU.  YOU WILL HAVE THE OPTION TO WAIT OR TO RESCHEDULE. 
Sincerely,                     
                         
Becky Winne                
Office Manager  

   
Registration Form 1

Fill Out Financial Form & Print

Registration Form 2

Fill Out History Form & Print

Registration Form 3
   

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