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
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.
(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.