top of page

New Patient Registration 

  • Please bring current insurance cards

​

  • Please bring photo identification such as a drivers license

​

  • If possible, please print and fill out the HIPAA Agreement

    • This agreement ensures that the Brookside will maintain the confidentiality and secrecy of protected health and all other patient information.

​

​

​

​

​

​

  • If possible, please print and fill out the Patient Communication Form

    • This agreement gives Brookside permission to share your information with individuals of your choosing.  It also lets Brookside know how you prefer to be contacted.

​

​

​

​

​

​

  • ​If possible, please print and fill out the Records Request Form

    • ​This form allows Brookside to request records from your previous PCP​​​.

​

​

​

​

​

​​​​​​

bottom of page