If possible, please print, fill out and bring the appropriate forms below when you come to your appointment.

Privacy Policy

Patient Registration Forms

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)

Authorization to Disclose PHI

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.