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New Patient Forms

If you're a first-time client, please print and complete the following forms. Include a copy of your insurance card front and back.  Email or fax completed forms to:  gary@drgarychase.com or 866-409-7750.

New Patient Packet

New Patient Forms in Word

Click on the file to open the word document.  You will then be able to fill in the form in Word.  Please print or save document and email the completed document and a copy of your insurance card, front and back, to gary@drgarychase.com or fax completed document to 866-409-7750.


New Patient Forms in PDF

Click on the file to open the PDF document in Adobe Acrobat Reader.  If you do not have Adobe Acrobat Reader, please click on the link below.  Print the form and complete.  Email the completed document and a copy of your insurance card, front and back, to gary@drgarychase.com or fax completed document to 866-409-7750.


Note: To download Adobe Acrobat Reader for free, click here.

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Helpful Forms

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