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