New Patient Registration

Excellent. You've made it this far! Now let's make it official.

Please complete the registration form below as thoroughly as you can. The more I know about your health, the better prepared I'll be before we meet, which means we can spend less time playing scribe and more time helping you feel better.

That said, don't overthink it. This isn't a college entrance exam, and there are no trick questions. If you're not sure about something, take your best guess – we’ll sort out the details during your visit. Keep moving!

A few quick notes:

Your information is secure. This form is HIPAA-compliant, so everything you share is private and protected by law.

Double-check your email address. You'll receive a copy of your completed registration via email.

One last thing: I'll send you a payment link separately, usually by text message. But we’ll worry about it later. Right now, let's conquer the paperwork.

See you soon!

person using silver laptop computer on desk
person using silver laptop computer on desk
a man with a beard and glasses posing for a picture
a man with a beard and glasses posing for a picture
woman in black blazer with brown hair
woman in black blazer with brown hair
man standing near white wall
man standing near white wall
woman in white long sleeve shirt smiling
woman in white long sleeve shirt smiling