Patient Information & Forms

Notice of Privacy Practices

We care about your personal and medical information. Please review the Notice about how your information is used and disclosed, and how you can get access to this information.

We ask all our new patients to fill out the forms below before their first appointment. To save time at the office, click on the links below, print the forms and fill them out before your first visit to Miramar.

English

New Patient Information

Medical History Questionnaire

Release of Medical Information

Information Release Authorization

We ask all our new patients to fill out the forms below before their first appointment. To save time at the office, click on the links below, print the forms and fill them out before your first visit to Miramar.

Spanish

Información
del Paciente

Historial
Médico

Divulgación de Información Médica

Note: You will need Adobe Acrobat Reader to view these forms. If you do not have Adobe Acrobat Reader, you may download it by clicking on the icon below.