Are you a New Patient?

If so, please fill out the form below, or download it by clicking here. You can also have your doctor fax us your patient & insurance information to us at 866-860-9358.


Our team will obtain your benefits and contact you prior to your scheduled evaluation and measuring appointment.


If you need the Spanish version of this form,  please click here to download.

New Patient

Patient Information

Emergency Contact Information

Insurance Information

Referral Information