FORMS (PDF version for printing and signing; return to clinic by mail, fax, or email)
FORMS (DocuSign version for electronic completion; please retain a copy for your records after completion. Your responses will be automatically sent to the Clinic)
Please keep in mind that some electronic communications, including those via unencrypted email, are not secure. Although it is unlikely, there is a possibility that information you include in an electronic form or email can be intercepted and/or inadvertently read by other parties besides the person for whom it is intended. Please do not submit your information electronically unless you are comfortable with these risks.