New Patient Forms

Filling out the following form and bringing them to first visit will save time at the office:

Patient Records Release

So that we will have more complete medical history, new patients should complete the Medical Records Release and send to your current healthcare facility. Contact them to find out where to send the form.  Fax the completed form to TLC at 877-673-1592. We will review the form for accuracy and transmit the form to your current provider. If your provider is someone other than Centura, please provide the fax number of the provider who has the records to the “To” field on the form.

Patient Forms

Other Patient Forms

Fill these out if requested​​