You can decrease time spent in the office and ensure on-schedule appointments by completing these forms
prior to your visit. Otherwise, please arrive 15-20 minutes prior to your scheduled appointment time.
You will need a .pdf viewer, such as Adobe Reader, to open the files.
Click here to download Adobe Reader.
Printing tips: when printing the forms, please select 'fit to printable area' or
'shrink to printable area' under 'page scaling.' Otherwise, the form edges may be
cut off. It is okay to print in black and white.
You may verify if we accept your insurance online.
If you are a new patient to the practice (even if you have seen Dr. Itharat at his former location),
you must complete the following forms,
If you are scheduled for an annual exam, you must complete the following forms,
If you are returning for a follow-up visit AND your last visit has been less than one year
ago, you do not have to complete any forms (unless there has been a change in your address,
medical insurance, or medical history - if so, please update the forms below).