The registration forms you will need prior to you appointment are below. The forms are designed for you to conveniently complete online and print prior to your scheduled appointment.
NEW for 2024: Download a PDF version of the form to print and bring with you to your appointment, or fill out a secure electronic version of the form for faster service.
Authorization to Disclose PHI Form (Fill Out PDF, Print, Bring to Appointment)
Authorization to Disclose PHI Form (Espanol)
Authorization to Disclose PHI Form Online (Fill Out all Fields Online, Submit Online Using Form Submit Button)
HIPAA Compliance Patient Consent Form (Fill Out PDF, Print, Bring to Appointment)
HIPAA Compliance Patient Consent Form (Espanol)
HIPAA Compliance Patient Consent Form Online (Fill Out all Fields Online, Submit Online Using Form Submit Button)
HIPAA Compliance Patient Consent Form Annual Update (Fill Out PDF, Print, Bring to Appointment)
HIPAA Compliance Patient Consent Form Annual Update (Espanol)
HIPAA Compliance Patient Consent Form Annual Update Form Online (Fill Out all Fields Online, Submit Online Using Form Submit Button)
Annual Update Registration Form (Fill Out PDF, Print, Bring to Appointment)
Annual Update Registration Form (Espanol)
Annual Update Registration Form Online (Fill Out all Fields Online, Submit Online Using Form Submit Button)
Patient Health History Form (Fill Out PDF, Print, Bring to Appointment)
Patient Health History Form (Espanol)
Patient Health History Form Online (Fill Out all Fields Online, Submit Online Using Form Submit Button)
My Medicine List Form (Fill Out PDF, Print, Bring to Appointment)
My Medicine List Form (Espanol)
My Medicine List Form Online (Fill Out all Fields Online, Submit Online Using Form Submit Button)
Privacy Practices Form
Privacy Practices Form (Espanol)
After Care Instructions for Skin Procedures
After Care Instructions for Skin Procedures (Espanol)
FAA Physical - 1st, 2nd & 3rd Class Exams
Bring FAA MedXPress documents to your appointment. Forms can be found at https://medxpress.faa.gov
