Patient Intake Form | Patient Forms

Patient Forms Patient Intake Form

Please call 605-642-5196 to schedule an initial appointment before submitting this paperwork.
If you have not been seen as a patient in more than three years, please fill out this form to update your information.

Please fill out the Pediatric Intake Form if the patient is under the age of 3. 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.