Patient Forms

Planning your visit? Download information and patient forms to complete in advance of your first – or next – visit. Email info/at/ if you have any questions about what forms you may need to complete.

Pre Visit Instructions

Authorization Forms

Credit Card Security

The privacy and security of your personal health and financial data is very important to us. When we ask to secure a credit card for payment purposes, you can be assured the latest in security measures have been put in place to secure your credit card information. We have partnered with PayTrace security. Below is an overview of the security in place to protect your credit card information.

Overall Data Security

  • PayTrace is PCI DSS Validated and has been since 2005. 
  • Credit card data is stored within a Tier 3 high security data center. 
  • No sensitive credit card data is stored on our computers or servers within the office. 
  • Secure 256 bit SSL encryption is used for all communication over the internet and all customer payment account numbers are immediately encrypted upon entry into the system. 
  • PayTrace completes an on-site audit annually in order to maintain its PCI Certification. To learn more about PCI Certification, click here.

Data Center Security Features:

  • 24/7 on-site staff monitoring of physical and electronic network access. 
  • Three-factor authentication required for access. 
  • 24 hour video surveillance with a 60-day minimum retention policy. 
  • Visitors are escorted by authorized personnel at all times. 
  • Center built to be resistant to explosions, and other penetration threats. 

What are PCI Security Standards and the PCI Security Standards Council?

  • The Payment Card Industry Data Security Standard (PCI DSS) is a set of requirements designed to ensure that ALL companies that process, store or transmit credit card information maintain a secure environment. Essentially any merchant that has a Merchant ID (MID).
  • The Payment Card Industry Security Standards Council (PCI SSC) was launched on September 7, 2006 to manage the ongoing evolution of the Payment Card Industry (PCI) security standards with focus on improving payment account security throughout the transaction process. The PCI DSS is administered and managed by the PCI SSC (, an independent body that was created by the major payment card brands (Visa, MasterCard, American Express, Discover and JCB.).