Forms

Please bring  a copy of your forms completed and signed 15 minutes early to your scheduled appointment

 

Download Initial Patient Forms >>  (includes New Patient Forms, Policies, and Diet Diary)
In order to maximize your time with Dr. Manrique, please fill out the forms completely and bring them with you to your first appointment.  If you have medical records or lab tests that you would like Dr. Manrique to review, please bring an extra copy for us to keep in your patient file.

Medical Information Release Form >>
Download this release form if you would like to request your lab work and other medical records to be sent to Dr. Manrique for your upcoming appointment. Send this to your past doctor, but also let us know so we can follow up with them if we don’t receive your records within a week.

Infrared Mammography Patient Form >>
Bring this form with you when coming for your Infrared Mammography.
The Imaging Process >>
Please read before your Infrared Mammography