New patient paperwork
Fill these in before your first visit so Dr. Miranda can use your appointment for your care, not for forms. You can complete them here on this page, or open each one in its own window.
Where your answers go. Every form on this page is hosted by Healthie, the secure patient portal we use for your chart. What you type goes straight to Healthie. This website does not see it or store it.
Start here
Most new patients need only these two.
New patient intake packet
Your contact details, height and weight, medical history, medications, allergies, pharmacy, our financial policy and the telehealth consent, in one packet.
Consent packet
Our GLP-1 and compounded medication informed consent, and the HIPAA notice. Read each one, then sign.
Need just one form?
These are also included above. Use them only if our team asks for one on its own.
Telehealth consent
How a video or message visit works, what to expect, and your rights. Already included in the intake packet; use this one only if we ask for it on its own.
Patient information form
Name, date of birth, address and gender, for your chart. Use this one only if we ask for it on its own.
Not a patient yet? Start your application first. Questions about a form? Email us from the address on your confirmation and we will help.