New Patient Forms
Please print and complete the following forms and email them to Dr. Larocca using the button below.
*All information provided on the forms is kept private and is subject to doctor-patient confidentiality.
- Authorization for Disclosure of Health Information
- New Patient Information
- Notice of Privacy Practices (*No need to complete this form. This is for you to review only.)
- New Patient Medical History
- Weight Loss Consent Form
- HIPAA Disclosure (Consult Only)
- HIPAA Disclosure (1-Year Comprehensive Weight Loss Program)
Email completed documents to Kristine@doctorlarocca.com