Patient Forms

On your first visit, Dr. Clarke will have you fill out a Patient Intake Form. If you like, you may print out a copy now and complete it ahead of time. This form is in a PDF format. You will need Adobe Acrobat Reader to read it. If you do not have Adobe Acrobat Reader, you may download a free version.

Online Intake Form (Part 1) &
Online Intake Form (Part 2) or
Intake Form (PDF)

Child Consent Form

Pediatric Intake Form

Worker’s Comp/Personal Injury

HIPAA Privacy Form

Your Independent Medical Examination