Patient Intake Form | Patient Forms

Patient Forms Patient Intake Form

Call or text 605-642-5196 to schedule an appointment before submitting the Intake Form.
If you have not been seen as a patient in more than three years, fill out this form to update your information.

For patients under the age of 3, fill out the Pediatric Intake Form. Do not fill out this form in addition.

If the patient is under 18, a parent/guardian needs to sign the HIPAA form at the end of this form and be present at
the initial appointment to sign a consent to care for the minor patient.