Please complete this form to request that records be sent from another healthcare provider to our office. You may complete the form online and we will fax this to your provider or you may download the form and complete it by hand, and then fax or mail this to the office of your provider.

Click Here to Download and Complete this form by hand.

To request that records be sent specifically for participation in research studies please visit the website of our research collaborator: CenExel RMCR.

NEW PATIENTS
Please complete the Medication List before your appointment and bring it to your appointment, as we carefully review all medications at every visit.

If you are an established patient, we still require an updated medication list for each visit.
Please download, print, and complete an updated medication list the day before your appointment.

By signing this telemedicine consent form, you acknowledge that you understand and agree to participate in medical consultations and treatments via telecommunication technology. You recognize that while telemedicine offers convenience, it may have limitations compared to in-person visits. Rest assured, your privacy and confidentiality will be upheld to the highest standards. Thank you for embracing innovative healthcare solutions to ensure your well-being.

Please click to the left to sign this form electronically. To complete it by hand, Click Here to download.

If you wish to communicate with our staff via email, please complete the online email consent form. Your privacy and security are our top priorities.

Please click to the left to sign this form electronically. To complete it by hand, Click Here to download.

Send secure electronic communications and medical records to us for consideration of treatment or to request Huntington’s disease genetic testing appointments via the upload form. To submit documents or medical records regarding participation in clinical research trials, please visit the website of our research collaborator: CenExel RMCR