After booking an Initial New Patient Appointment, complete the intake form below. All information entered in this form is confidential. Once you click Submit, the form is sent to a HIPAA-compliant portal and is read only by practitioner. After each section, scroll up to find the next section of the form.

Instructions: Required fields are asterisked *. You may skip any and all questions that do not apply. After completing a section click "Next" to continue (you may need to scroll up to find the next section on your computer or phone). After the last page Mandatory Disclosure, please type your name and click "Submit."