Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

  • Child Patient Form  PDF
  • Adult Patient Form  PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

23 Hummer Rd
Ephrata, PA 17522
(717) 733-2147
Mon 8:00am to 6:00pm
Tue 8:00am to 5:00pm
Wed 8:00am to 5:00pm
Thu 8:00am to 2:00pm
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