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Patient Forms

Welcome to Dr. Roth's office!

New patients are ALWAYS welcome here.

We are committed to a stress free introduction to our office by making our patient registration forms available online. Please print these out and fill them out at your leisure and bring them to your first appointment with us. If you have any questions or problems downloading these forms please call us and ask, our front desk staff is happy to help you!


We look forward to seeing you soon!

Dr. Seth Roth and the Roth team


Click below to download New Patient Registration Materials


Patient Registration & Medical History Form

Financial and Insurance Office Policy

HIPAA Authorization of Release Form

Office Policy Regarding Insurance

Parental Financial Responsibility Form

Permission for Confirmation via Electronic Media

Release of Records