This Online Enrollment form is generated by the AtlasMD

​Electronic Health Record vendor and is geared primarily toward adult patients. 

Some elements in the form will not apply to your child.


You may scroll through those fields without entering the requested information.


​Please also note that it is not necessary to enter a method of payment --

that information is OPTIONAL.
​

Once we receive your enrollment request,

someone from our clinic will contact

​you to complete the process.

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ONLINE ENROLLMENT FORM

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