NEW PATIENTS – Please click the link below to fill out our online Patient Registration Form, Health History Form and our Disclaimer. Then print these out and bring them, along with your insurance card and a picture ID at the time of your appointment.
"Dr. Colliver and Staff – Thanks so much for fitting our son into your busy schedule and taking such good care of him. We are very appreciative. We thought your staff at the office and the staff at the surgery center were great! Our son is on the mend and we can’t thank you enough."
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)