All new patients must fill out and submit this form
with demographic and insurance information.
Consents & Acknowledgements
Submit this form
if you're a new patient, or if you need to update your CFC privacy preferences.
**IMPORTANT**
Don't fill out the form in your browser (download and open with Acrobat, or a similar pdf handler). Don't forget to fill out all required fields before submitting.
Documents
Privacy Practices
View the fine print
about our commitment to keep your information private.
