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PATIENT INFO & FORMS 

Young Doctor

01

Patient Handbook

Here you will find our patient handbook and various forms that you will need to complete for your first appointment with us. If you wish, please print these forms and fill out before you come in. If you are not able to print these at home, they can also be given to you during the check-in process.

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Patient Handbook: English / Spanish​​​

02

Sliding Fee Scale

Sliding Fee Application: English / Spanish

Medical, Optometry, Behavioral Health, and Podiatry Sliding Fee Scale: English / Spanish

Dental Sliding Fee Scale: English / Spanish

03

Medical

Medical History Questionnaire: English / Spanish

Authorization to use or disclose health information: English / Spanish

Permission for Treatment of Children: English / Spanish

Permission to Release Protected Health Information (HIPAA consent form): English / Spanish

Notice of Privacy Practices: English / Spanish

04

Dental

Initial Disclaimer Form: English / Spanish

HIPPA: English / Spanish

Dental Health History: English / Spanish

Consent for Dental Treatment: English / Spanish

Appointment Policy: English / Spanish

Enter The Client Portal

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