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Off Highway 50 – Down from Water Depot

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Patient Registration Form

Please complete the information below and submit the form online.  We need this information 48 hours before your appointment so the front desk or doctor can prepare for your visit.

This form contains confidential information and is delivered to your doctor through a secure Internet connection.

If you have more to tell us - please send us an email at


Adult Form
Child-Teen Form
Glasses Form
Contact Lens Form
Headache Form

For more information and up-to-date COVID-19 Procedures and Protocols, please click HERE.