For your convenience, You may fill out and submit the following forms online, or print and bring them to your next appointment:

Dr. Gindi's Patient Forms

• New Patient Medical History Form
• Health History Update

Dr. Valiathan's Patient Forms

• Child (Under 18) Medical History Form
• Adult Patient Health History Update

These forms require Adobe Acrobat Reader.
Click the Adobe logo to download.

*We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA compliant.

**For Apple/Mac Users: You must use Adobe Acrobat Reader to submit the forms. To do so, simply right click on the form and save form. Open form in Acrobat Reader, fill out the form and submit.