Patient Forms

Patient Forms


If you are a new patient or have not been seen by one of our providers during the previous three years, please fill out all four forms prior to your appointment.

If you are a returning patient but have not completed paperwork over the past two years, complete the first two forms prior to your appointment.

DAWPA Demographics Rev 5-24

DAWPA Receipt of Financial Policies and Notice of Privacy Practices

DAWPA Medical History Rev 5-24

DAWPA Medications and Allergies

Our physicians absolutely prefer that legal guardians accompany children. If a legal guardian cannot accompany a minor patient for their appointment, the consent provided below should be signed/returned to our practice.

DAWPA Consent to Treat a Minor

Upon your arrival, a Patient Care Coordinator will enter your demographic and insurance information into our computer system. They will also scan your current insurance card(s) and take your photograph.