Are you a new patient scheduled to visit our office? If so, please fill out the following form to the best of your ability and turn it in to our receptionist upon your visit. Thank You.
Please use Electronic Patient Intake Form, alternatively, you can print a paper copy to fill out below.
|Patient Information Form (must be filled out by all patients)|
|File Size:||130 kb|
|Fidelis Care - Change Primary Care Doctor to Hafeez Rehman, M.D. (must be filled out for Fidelis Patients)|
|File Size:||183 kb|
|HIPAA Authorization Form (must be filled out by all patients)|
|File Size:||63 kb|