Patient Forms

Online Forms

English

Español

Informacion del Paciente Nuevo

Downloadable Forms

English

HIPAA Privacy Authorization Form

Medications to Avoid Before Testing

Informed Consent for Telehealth Consultations

Email and Text Messaging Consent

Español

Informacion del Paciente Nuevo

Formulario de Autorización de Privacidad de HIPAA

Medicamentos a Evitar Antes de la Prueba

Consentimiento Informado para Consultas “Telesalud”

Consentimiento para Pruebas Cutáneas de Alergia

img.wp-smiley,img.emoji{display:inline !important;border:none !important;box-shadow:none !important;height:1em !important;width:1em !important;margin:0 .07em !important;vertical-align:-.1em !important;background:none !important;padding:0 !important;}.wp-block-audio figcaption{color:#555;font-size:13px;text-align:center;}.is-dark-theme .wp-block-audio figcaption{color:hsla(0,0%,100%,.65);}.wp-block-audio{margin:0 0 1em;}.wp-block-code{border:1px solid #ccc;border-radius:4px;font-family:Menlo,Consolas,monaco,monospace;padding:.8em 1em;}.wp-block-embed figcaption{color:#555;font-size:13px;text-align:center;}.is-dark-theme .wp-block-embed figcaption{color:hsla(0,0%,100%,.65);}.wp-block-embed{margin:0 0 1em;}.blocks-gallery-caption{color:#555;font-size:13px;text-align:center;}.is-dark-theme .blocks-gallery-caption{color:hsla(0,0%,100%,.65);}.wp-block-image figcaption{color:#555;font-size:13px;text-align:center;}.is-dark-theme .wp-block-image figcaption{color:hsla(0,0%,100%,.65);}.wp-block-image{margin:0 0 1em;}.wp-block-pullquote{border-bottom:4px solid;border-top:4px solid;color:currentColor;margin-bottom:1.75em;}.wp-block-pullquote cite,.wp-block-pullquote footer,.wp-block-pullquote__citation{color:currentColor;font-size:.8125em;font-style:normal;text-transform:uppercase;}.wp-block-quote{border-left:.25em solid;margin:0 0 1.75em;padding-left:1em;}.wp-block-quote cite,.wp-block-quote footer{color:currentColor;font-size:.8125em;font-style:normal;position:relative;}.wp-block-quote.has-text-align-right{border-left:none;border-right:.25em solid;padding-left:0;padding-right:1em;}.wp-block-quote.has-text-align-center{border:none;padding-left:0;}.wp-block-quote.is-large,.wp-block-quote.is-style-large,.wp-block-quote.is-style-plain{border:none;}.wp-block-search .wp-block-search__label{font-weight:700;}.wp-block-search__button{border:1px solid #ccc;padding:.375em .625em;}:where(.wp-block-group.has-background){padding:1.25em 2.375em;}.wp-block-separator.has-css-opacity{opacity:.4;}.wp-block-separator{border:none;border-bottom:2px solid;margin-left:auto;margin-right:auto;}.wp-block-separator.has-alpha-channel-opacity{opacity:1;}.wp-block-separator:not(.is-style-wide):not(.is-style-dots){width:100px;}.wp-block-separator.has-background:not(.is-style-dots){border-bottom:none;height:1px;}.wp-block-separator.has-background:not(.is-style-wide):not(.is-style-dots){height:2px;}.wp-block-table{margin:0 0 1em;}.wp-block-table td,.wp-block-table th{word-break:normal;}.wp-block-table figcaption{color:#555;font-size:13px;text-align:center;}.is-dark-theme .wp-block-table figcaption{color:hsla(0,0%,100%,.65);}.wp-block-video figcaption{color:#555;font-size:13px;text-align:center;}.is-dark-theme .wp-block-video figcaption{color:hsla(0,0%,100%,.65);}.wp-block-video{margin:0 0 1em;}.wp-block-template-part.has-background{margin-bottom:0;margin-top:0;padding:1.25em 2.375em;}body{--wp--preset--color--black:#000;--wp--preset--color--cyan-bluish-gray:#abb8c3;--wp--preset--color--white:#fff;--wp--preset--color--pale-pink:#f78da7;--wp--preset--color--vivid-red:#cf2e2e;--wp--preset--color--luminous-vivid-orange:#ff6900;--wp--preset--color--luminous-vivid-amber:#fcb900;--wp--preset--color--light-green-cyan:#7bdcb5;--wp--preset--color--vivid-green-cyan:#00d084;--wp--preset--color--pale-cyan-blue:#8ed1fc;--wp--preset--color--vivid-cyan-blue:#0693e3;--wp--preset--color--vivid-purple:#9b51e0;--wp--preset--color--primary:#006ca4;--wp--preset--color--secondary:#f47e50;--wp--preset--color--tertiary:#006ca4;--wp--preset--color--quaternary:#242424;--wp--preset--color--dark:#2e353e;--wp--preset--color--light:#fff;--wp--preset--gradient--vivid-cyan-blue-to-vivid-purple:linear-gradient(135deg,rgba(6,147,227,1) 0%,#9b51e0 100%);--wp--preset--gradient--light-green-cyan-to-vivid-green-cyan:linear-gradient(135deg,#7adcb4 0%,#00d082 100%);--wp--preset--gradient--luminous-vivid-amber-to-luminous-vivid-orange:linear-gradient(135deg,rgba(252,185,0,1) 0%,rgba(255,105,0,1) 100%);--wp--preset--gradient--luminous-vivid-orange-to-vivid-red:linear-gradient(135deg,rgba(255,105,0,1) 0%,#cf2e2e 100%);--wp--preset--gradient--very-light-gray-to-cyan-bluish-gray:linear-gradient(135deg,#eee 0%,#a9b8c3 100%);--wp--preset--gradient--cool-to-warm-spectrum:linear-gradient(135deg,#4aeadc 0%,#9778d1 20%,#cf2aba 40%,#ee2c82 60%,#fb6962 80%,#fef84c 100%);--wp--preset--gradient--blush-light-purple:linear-gradient(135deg,#ffceec 0%,#9896f0 100%);--wp--preset--gradient--blush-bordeaux:linear-gradient(135deg,#fecda5 0%,#fe2d2d 50%,#6b003e 100%);--wp--preset--gradient--luminous-dusk:linear-gradient(135deg,#ffcb70 0%,#c751c0 50%,#4158d0 100%);--wp--preset--gradient--pale-ocean:linear-gradient(135deg,#fff5cb 0%,#b6e3d4 50%,#33a7b5 100%);--wp--preset--gradient--electric-grass:linear-gradient(135deg,#caf880 0%,#71ce7e 100%);--wp--preset--gradient--midnight:linear-gradient(135deg,#020381 0%,#2874fc 100%);--wp--preset--duotone--dark-grayscale:url("#wp-duotone-dark-grayscale");--wp--preset--duotone--grayscale:url("#wp-duotone-grayscale");--wp--preset--duotone--purple-yellow:url("#wp-duotone-purple-yellow");--wp--preset--duotone--blue-red:url("#wp-duotone-blue-red");--wp--preset--duotone--midnight:url("#wp-duotone-midnight");--wp--preset--duotone--magenta-yellow:url("#wp-duotone-magenta-yellow");--wp--preset--duotone--purple-green:url("#wp-duotone-purple-green");--wp--preset--duotone--blue-orange:url("#wp-duotone-blue-orange");--wp--preset--font-size--small:13px;--wp--preset--font-size--medium:20px;--wp--preset--font-size--large:36px;--wp--preset--font-size--x-large:42px;--wp--preset--spacing--20:.44rem;--wp--preset--spacing--30:.67rem;--wp--preset--spacing--40:1rem;--wp--preset--spacing--50:1.5rem;--wp--preset--spacing--60:2.25rem;--wp--preset--spacing--70:3.38rem;--wp--preset--spacing--80:5.06rem;--wp--preset--shadow--natural:6px 6px 9px rgba(0,0,0,.2);--wp--preset--shadow--deep:12px 12px 50px rgba(0,0,0,.4);--wp--preset--shadow--sharp:6px 6px 0px rgba(0,0,0,.2);--wp--preset--shadow--outlined:6px 6px 0px -3px rgba(255,255,255,1),6px 6px rgba(0,0,0,1);--wp--preset--shadow--crisp:6px 6px 0px rgba(0,0,0,1);}:where(.is-layout-flex){gap:.5em;}body .is-layout-flow > .alignleft{float:left;margin-inline-start:0;margin-inline-end:2em;}body .is-layout-flow > .alignright{float:right;margin-inline-start:2em;margin-inline-end:0;}body .is-layout-flow > .aligncenter{margin-left:auto !important;margin-right:auto !important;}body .is-layout-constrained > .alignleft{float:left;margin-inline-start:0;margin-inline-end:2em;}body .is-layout-constrained > .alignright{float:right;margin-inline-start:2em;margin-inline-end:0;}body .is-layout-constrained > .aligncenter{margin-left:auto !important;margin-right:auto !important;}body .is-layout-constrained > :where(:not(.alignleft):not(.alignright):not(.alignfull)){max-width:var(--wp--style--global--content-size);margin-left:auto !important;margin-right:auto !important;}body .is-layout-constrained > .alignwide{max-width:var(--wp--style--global--wide-size);}body .is-layout-flex{display:flex;}body .is-layout-flex{flex-wrap:wrap;align-items:center;}body .is-layout-flex > *{margin:0;}:where(.wp-block-columns.is-layout-flex){gap:2em;}.has-black-color{color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-color{color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-color{color:var(--wp--preset--color--white) !important;}.has-pale-pink-color{color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-color{color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-color{color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-color{color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-color{color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-color{color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-color{color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-color{color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-color{color:var(--wp--preset--color--vivid-purple) !important;}.has-black-background-color{background-color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-background-color{background-color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-background-color{background-color:var(--wp--preset--color--white) !important;}.has-pale-pink-background-color{background-color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-background-color{background-color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-background-color{background-color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-background-color{background-color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-background-color{background-color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-background-color{background-color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-background-color{background-color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-background-color{background-color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-background-color{background-color:var(--wp--preset--color--vivid-purple) !important;}.has-black-border-color{border-color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-border-color{border-color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-border-color{border-color:var(--wp--preset--color--white) !important;}.has-pale-pink-border-color{border-color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-border-color{border-color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-border-color{border-color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-border-color{border-color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-border-color{border-color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-border-color{border-color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-border-color{border-color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-border-color{border-color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-border-color{border-color:var(--wp--preset--color--vivid-purple) !important;}.has-vivid-cyan-blue-to-vivid-purple-gradient-background{background:var(--wp--preset--gradient--vivid-cyan-blue-to-vivid-purple) !important;}.has-light-green-cyan-to-vivid-green-cyan-gradient-background{background:var(--wp--preset--gradient--light-green-cyan-to-vivid-green-cyan) !important;}.has-luminous-vivid-amber-to-luminous-vivid-orange-gradient-background{background:var(--wp--preset--gradient--luminous-vivid-amber-to-luminous-vivid-orange) !important;}.has-luminous-vivid-orange-to-vivid-red-gradient-background{background:var(--wp--preset--gradient--luminous-vivid-orange-to-vivid-red) !important;}.has-very-light-gray-to-cyan-bluish-gray-gradient-background{background:var(--wp--preset--gradient--very-light-gray-to-cyan-bluish-gray) !important;}.has-cool-to-warm-spectrum-gradient-background{background:var(--wp--preset--gradient--cool-to-warm-spectrum) !important;}.has-blush-light-purple-gradient-background{background:var(--wp--preset--gradient--blush-light-purple) !important;}.has-blush-bordeaux-gradient-background{background:var(--wp--preset--gradient--blush-bordeaux) !important;}.has-luminous-dusk-gradient-background{background:var(--wp--preset--gradient--luminous-dusk) !important;}.has-pale-ocean-gradient-background{background:var(--wp--preset--gradient--pale-ocean) !important;}.has-electric-grass-gradient-background{background:var(--wp--preset--gradient--electric-grass) !important;}.has-midnight-gradient-background{background:var(--wp--preset--gradient--midnight) !important;}.has-small-font-size{font-size:var(--wp--preset--font-size--small) !important;}.has-medium-font-size{font-size:var(--wp--preset--font-size--medium) !important;}.has-large-font-size{font-size:var(--wp--preset--font-size--large) !important;}.has-x-large-font-size{font-size:var(--wp--preset--font-size--x-large) !important;}.wp-block-navigation a:where(:not(.wp-element-button)){color:inherit;}:where(.wp-block-columns.is-layout-flex){gap:2em;}.wp-block-pullquote{font-size:1.5em;line-height:1.6;}#rs-demo-id{}.tparrows:before{color:#006ca4;text-shadow:0 0 3px #fff;}.revslider-initialised .tp-loader{z-index:18;}#header .logo,.side-header-narrow-bar-logo{max-width:290px;}@media (min-width:1170px){#header .logo{max-width:290px;}}@media (max-width:991px){#header .logo{max-width:290px;}}@media (max-width:767px){#header .logo{max-width:290px;}}@media (min-width:992px){}#header .header-main .header-left,#header .header-main .header-center,#header .header-main .header-right,.fixed-header #header .header-main .header-left,.fixed-header #header .header-main .header-right,.fixed-header #header .header-main .header-center{padding-top:30px;padding-bottom:30px;}.page-top .sort-source{position:static;text-align:center;margin-top:5px;border-width:0;}.page-top{padding-top:20px;padding-bottom:20px;}.page-top .page-title{padding-bottom:0;}@media (max-width:991px){.page-top .page-sub-title{margin-bottom:5px;margin-top:0;}.page-top .breadcrumbs-wrap{margin-bottom:5px;}}@media (min-width:992px){.page-top .page-title{min-height:0;line-height:1.25;}.page-top .page-sub-title{line-height:1.6;}}@media (min-width:992px){.page-top .breadcrumb{-webkit-justify-content:flex-end;-ms-flex-pack:end;justify-content:flex-end;}}.header-top .nav-item-borders{border-right:1px solid rgba(0,0,0,.06);padding-left:12px;padding-right:12px;}.header-top .nav-item-borders>*{display:inline-block;padding:5px 10px;}.header-top .nav-item-borders i{font-size:15.12px;}#header .header-contact i{margin-left:0;margin-right:4px;}#footer .footer-bottom{padding:6px;border-top:1px solid #53585e;}#footer .widget-title{margin-bottom:1.5rem;font-size:17.64px;letter-spacing:-.05em;text-transform:none;line-height:27px;}#footer .footer-main>.container{padding-top:3rem;padding-bottom:1.4rem;}#footer a strong{display:block;font-size:30px;line-height:1;}#footer .custom-info span:nth-child(1){color:#95989c;}.custom-info span:nth-child(1){display:inline-block;color:#90c9ea;min-width:68px;margin-right:10px;}.custom-info span:nth-child(1)::after{content:":";display:block;float:right;color:#fff;}.widget.follow-us .share-links a{margin:0;}.page-top .page-title{font-size:28px;line-height:1;}.page-top ul.breadcrumb>li .delimiter{width:13px;}.page-top .breadcrumbs-wrap li:last-child{opacity:.7;}.page-top .delimiter{opacity:.5;}p.lead{line-height:1.8rem;letter-spacing:-.05em;font-size:1.2rem;}.main-content{padding-top:33px;padding-bottom:0;}.left-sidebar{padding-top:48px;}.sidebar-content .widget h3{margin-bottom:30px;font-size:19.6px;font-weight:600;text-transform:none;letter-spacing:-.05em;}.sidebar-content li{padding:7.5px 0 7.5px 23px !important;line-height:20px;}.sidebar-content .widget ul{border-bottom-width:0;}.sidebar-content li a{font-size:12.6px;}.elementor-toggle-icon i{width:24px;height:24px;background-color:#008fe2;font-size:7px;line-height:24px;border-radius:3px;text-align:center;}.elementor-toggle .elementor-tab-title .elementor-toggle-icon{width:24px;}.elementor-tab-title{display:inline-flex;align-items:center;}.elementor-toggle-item a:hover{text-decoration:none;}.left-sidebar{order:-1;}@media (max-width:991px){.container-fluid section.elementor-top-section{padding-left:20px !important;padding-right:20px !important;}.left-sidebar{padding-bottom:0;}}@media (max-width:575px){.depart-box .porto-sicon-left{display:none;}.depart-toggle .elementor-widget-container{padding:20px 0 0 !important;}}.usa_flag h2,.spain_flag h2{padding:20px 10px 0 20px;}.usa_flag h2,.spain_flag h2{margin-bottom:30px;}.downloadable_forms h4:before{content:url("https://cdn-cmdho.nitrocdn.com/ouzISqbSZYQrazKbSigpJevKqMcDOKnL/assets/images/source/rev-0cedc92/wp-content/uploads/2020/12/pdf-1.png");margin-right:10px;vertical-align:middle;}.online_form h4:before{content:url("https://cdn-cmdho.nitrocdn.com/ouzISqbSZYQrazKbSigpJevKqMcDOKnL/assets/images/source/rev-0cedc92/wp-content/uploads/2020/12/google-forms-1.png");margin-right:10px;vertical-align:middle;}.downloadable_forms h4,.online_form h4{font-size:18px !important;display:flex;width:100%;}.notice_text,.search-results span.meta-author,.single-location .Bottom_area{display:none;}@media (max-width: 767px){.single-location .Location_top .location-info-col .location-name{text-align:center !important;margin:20px 10px;}}.location_content{padding-top:25px;}span.meta-author{display:none;}.blog .posts-medium-alt .blog-post-date,article.post .post-date,.blog span.meta-author,.single-post .clearfix,body.single-post article.post .post-meta{display:none;}.mailpoet_hp_email_label{display:none !important;}#mailpoet_form_1 .mailpoet_form{}#mailpoet_form_1 .mailpoet_column_with_background{padding:10px;}#mailpoet_form_1 .mailpoet_form_column:not(:first-child){margin-left:20px;}#mailpoet_form_1 .mailpoet_paragraph{line-height:20px;margin-bottom:20px;}#mailpoet_form_1 .mailpoet_segment_label,#mailpoet_form_1 .mailpoet_text_label,#mailpoet_form_1 .mailpoet_textarea_label,#mailpoet_form_1 .mailpoet_select_label,#mailpoet_form_1 .mailpoet_radio_label,#mailpoet_form_1 .mailpoet_checkbox_label,#mailpoet_form_1 .mailpoet_list_label,#mailpoet_form_1 .mailpoet_date_label{display:block;font-weight:normal;}#mailpoet_form_1 .mailpoet_text,#mailpoet_form_1 .mailpoet_textarea,#mailpoet_form_1 .mailpoet_select,#mailpoet_form_1 .mailpoet_date_month,#mailpoet_form_1 .mailpoet_date_day,#mailpoet_form_1 .mailpoet_date_year,#mailpoet_form_1 .mailpoet_date{display:block;}#mailpoet_form_1 .mailpoet_text,#mailpoet_form_1 .mailpoet_textarea{width:200px;}#mailpoet_form_1 .mailpoet_checkbox{}#mailpoet_form_1 .mailpoet_submit{}#mailpoet_form_1 .mailpoet_divider{}#mailpoet_form_1 .mailpoet_message{}#mailpoet_form_1 .mailpoet_form_loading{width:30px;text-align:center;line-height:normal;}#mailpoet_form_1 .mailpoet_form_loading > span{width:5px;height:5px;background-color:#5b5b5b;}#mailpoet_form_1{border-radius:0px;text-align:left;}#mailpoet_form_1 form.mailpoet_form{padding:20px;}#mailpoet_form_1{width:100%;}#mailpoet_form_1 .mailpoet_message{margin:0;padding:0 20px;}#mailpoet_form_1 .mailpoet_paragraph.last{margin-bottom:0;}@media (max-width: 500px){#mailpoet_form_1{background-image:none;}#mailpoet_form_1.nitro-lazy{background-image:none !important;}}@media (min-width: 500px){#mailpoet_form_1 .last .mailpoet_paragraph:last-child{margin-bottom:0;}}@media (max-width: 500px){#mailpoet_form_1 .mailpoet_form_column:last-child .mailpoet_paragraph:last-child{margin-bottom:0;}}

Online Forms

English

Patient Registration Form

New Patient Medical History

Español

Informacion del Paciente Nuevo

Historial Médico del Paciente

Downloadable Forms

English

Patient Registration Form

New Patient Medical History

Financial Agreement

HIPAA Privacy Authorization Form

Record Release

Medications to Avoid Before Testing

Informed Consent for Telehealth Consultations

Email and Text Messaging Consent

COVID 19 Triage Form

Español

Informacion del Paciente Nuevo

Historial Médico del Paciente

Acuerdo Financiero

Formulario de Autorización de Privacidad de HIPAA

Medicamentos a Evitar Antes de la Prueba

Consentimiento Informado para Consultas “Telesalud”

Consentimiento para Pruebas Cutáneas de Alergia