New Patient Forms

You can download New Patient Forms as needed using the links below.

Please print and complete the forms prior to your arrival. This will speed up your registration process.

New Patient Information Form

Privacy Acknowledgement Form

Assignment of Benefits Form

Patient Clinical Information

Record Release Authorization

Patient’s Appeal Consent Form

Insurance Information

Our goal is to provide the best healthcare experience for the our patients. We accept all insurance plans for your initial consultation. Visits and treatments beyond your initial visit will need to certified by your health insurance provider.

“Dr Alshafie is not only a skilled surgeon, but a compassionate fine man. His surgical staff was exceptional.”

— Leslie Michaels

There are no words I can say but thank you for being such a great doctor and helping me.”

— Pat Demasi