New Patient Registration

Please fill out All New Patient Registration forms (located down below) and drop off at the office or email to admin@optimalcw.com. 

You must submit the New Patient Registraton forms in order to schedule an appointment.

Please call office to obtain Weight Loss registration forms via email or you may fill them out at the office the day of your appointment. 

• An "authorization to release protected health information" (PHI) is a document that, when signed, allows healthcare providers to share a patient’s protected health information with specified individuals or organizations, according to the details stipulated in the form.

• A signed authorization form must be obtained from a patient before their protected health information can be shared with other individuals or organizations.

• To submit a request for medical release of information, please download and complete the '"Medical Records Request" form (located at bottom of page) and submit along with a photo ID. 

• You can submit in person at the office, email, or fax to 928-267-4091.

• Please allow 3-5 business days to receive your records.

• Please call 928-257-1223 with any questions.