If possible, please print, fill out and bring the appropriate forms below when you come to your appointment.
Medical Records Release English / Spanish
Patient Forms – Dr. Briggs’
Patient Forms – Dr. St. Clair, Fumich & Udo-Inyang Patients
Patient Forms – Dr. Dasari’s New Patients for Pain Management
Patient Forms– Dr. Hensley’s
Patient Forms – Dr. Otte’s (This form is for Pediatric Patients Only)
All forms are in Adobe PDF format and require Adobe Reader to be installed on your computer in order to be able to open them. If you do not have Adobe Reader, please use the link below.
Statements With Dates Prior to 4/10
Statements With Dates 4/11 or After