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 2020: 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.
New Patient Registration Form
New Patient Registration Form (Espanol)
New Patient Registration Form Online
Authorization to Disclose PHI Form
Authorization to Disclose PHI Form (Espanol)
Authorization to Disclose PHI Form Online
HIPAA Compliance Patient Consent Form
HIPAA Compliance Patient Consent Form (Espanol)
HIPAA Compliance Patient Consent Form Online
HIPAA Compliance Patient Consent Form Annual Update
HIPAA Compliance Patient Consent Form Annual Update (Espanol)
Annual Update Registration Form
Annual Update Registration Form (Espanol)
Patient Health History Form
Patient Health History Form (Espanol)
Patient Health History Form Online
My Medicine List Form
My Medicine List Form (Espanol)
My Medicine List Form Online
Privacy Practices Form
Privacy Practices Form (Espanol)
FAA Physical - 2nd and 3rd Class
Bring FAA MedXPress documents to your appointment. Forms can be found at https://medxpress.faa.gov