Patient forms
How can we help?
Choose the form that best matches your request. Submitting the right form helps our team route your message faster and keep each request organized.
Before you submit
- Use one form per request.
- Include complete patient details.
- Do not use forms for emergencies.
Choose the right form
Find your form by category
Each card includes the forms most commonly used for that type of request.
New patients
Register and set preferences
Start care, register online, or authorize billing-related text messages.
Existing patients
Care requests and records
Use these forms for appointments, referrals, telehealth consent, or record release requests.
Referral & health plans
Referral concern or change
For referral follow-up, submitted referral changes, or HMO / IPA / health plan requests.
Account & billing
Billing and communication
For account questions, billing support, SMS consent, or unsubscribe requests.
Support & feedback
Technical help or feedback
For portal or website issues, technical support, feedback, concerns, or complaints.
For urgent medical concerns
Do not use online forms for urgent or life-threatening concerns. Call 911 or go to the nearest emergency department if you believe you are experiencing an emergency.
1. Pick the best category
Start with the category that matches your request so it reaches the correct team.
2. Submit one request
Use one form per unique request so each item can be tracked clearly.
3. Our team routes it
Form requests help reduce hold time and route your message faster than voicemail.
Not sure which form to use?
Contact our office and our team can help route your concern to the correct department.