About Us
Services
Insurance
Vaccine Schedule
Home
Before Your Visit
Appointments
Contact Us
FAQ's
  Applications
 

Registration is an important step after you have scheduled your first appointment. It helps us collect basic patient information and create new medical record. Please print, fill in the forms below and bring them with you when you visit the doctor's clinic. "This speeds up your visit."

New Patient Forms
These forms are all in Adobe Acrobat (.pdf) format.
They can be downloaded and printed out, but cannot be filled out online. To obtain a free copy of Adobe Acrobat Reader, click here.
 PATIENT REGISTRATION FORM
This form tells us all of your basic identification information, and how to reach you. We request that this form be filled out before the first office visit.
 PRENATAL PATIENT INFORMATION FORM
This form tells us all of your basic identification information, and prenatal information. We request that this form be filled out before the first prenatal visit.
 PATIENT HISTORY INFORMATION FORM
The following information is very important to your health. Please take the time to fully and accurately fill out this form before the first office visit.
 MEDICAL RECORD RELEASE FORM
This form gives us authorization to release patient's health information.
 PHARMACY INFORMATION FORM
This form gives us authorization to release patient's health information.

Applications
2006 Dr.Parekh E-Clinic. All rights reserved. | Privacy | Contact Us
Site Designed & Maintained by: VERIDES INC