Patient Forms

Fill it in online

If you'd like to submit your basic information electronically, CLICK HERE and fill out the form. If you prefer to bring the form with you to our office, follow the instructions to download the forms below. You must bring your insurance card with you to your appointment.


Download and complete forms before your visit. You will need Acrobat Reader -- a free program -- to view these forms. If you don't have Acrobat Reader, click here for a free download that allows you to read this and other .pdf  documents

Patient information form

(24k .pdf)
Please download this, print it out and bring the completed form with you to your first appointment at Plaza Primary Care & Geriatrics. This is for new patients, and for existing patients who have not yet been to the new office.

Health Questionnaire

(2.5 mb .pdf file)
NEW patients should download this form, fill it out and bring it to your first appointment. Please complete the entire three-page form.