• This paperwork is HIPAA compliant and secure. If you would prefer to print the paperwork and bring it to the office or fax it, please scroll to the bottom of the page.

  • If you have any questions, call us at (256)534-8161.

  • Our policy is that we do not schedule appointments until this paperwork is completed.

  • Please allow us two business days to contact you after you submit this form. 

  • Please send photos or scans of the fronts and backs of your ID and Insurance cards to


If you would prefer to print off the paperwork and fax it or bring it to the office, please download the PDF below.