Copyright © 2007-2017 Dr. Hany Mekhael M.D. PLLC, All rights Reserved.

New Patient Forms

Please click on the appropriate form below.
The New Patient Registration form is available below. All new patients are asked to download, print and complete this form in advance of their appointment. (Please remember to bring this form and all your insurance cards with you at the time of your appointment.)

You will be asked to complete the Patient Registration Form at the time of the appointment. In addition, we ask that you complete the other forms  that are available below.

If you have a problem seeing any of the following forms in your browser, you can right click on the

form's link and choose 'Save target as' to save the form to your hard drive and then open it from there

Patient Registration Form

Acknowledgement of Receipt of Notice of Privacy Information Practices

Related Documents:

New Patient Policy Statement

Privacy Notice For Patients

You may print these forms, complete the information and
 

  1. Bring them in at your schedule new patient appointment time, or

  2. Mail the forms to the appropriate office address with your appointment date noted at the top.