Our intake form collects details from our new patients in order to provide treatment and to accurately bill our fees. You can save time by downloading and printing the Patient Registration form, fill in the information at your convenience, and bring the form with you on your appointment date.
Please be sure to complete all the registration fields, with your full name, your medical history, the person who will be responsible for settling the account, and any applicable insurance information, then bring it along with you for your visit.
Download the forms here: Patient Registration form for Dr. Brock Thomas.
If you would like, you may also fax the form to our office. Fax: (707) 539-7501.