Patient Forms

It is very important to have a complete medical history prior to your appointment. Please enter your information into the patient portal AT LEAST three days before your appointment.

Feel free to contact our office if you are having difficulty so that a staff member can assist you. Check your spam folder for PatientNow Notifications if you have not see an email with the link in your “inbox”.

It will take 15 – 20 minutes to follow the instructions below to register and complete the New Patient Paperwork on the portal.

  1. Click here to access the patient portal Click the Register button to create a username and password.
  2. Then you will receive an email from PatientNOW Notifications – Click on the link that says Get Access.
  3. Log in using the username and password you created earlier and answer the questions that follow.

If you are an existing patient and have changes to your medications or medical history, please update them by logging on the patient portal.

If you are having trouble with the portal, and are unable to enter the information online, please complete the paperwork listed in the links below and email them to frontdesk@diehlplastics.com no later than three (3) days prior to your appointment.

Por favor, llene los siguientes formularios.

Estos se deben remitir por email a: frontdesk@diehlplastics.com

Si fuese posible, traiga consigo una copia de estos formularios a nuestra oficina (para evitar duplicarlos el día de su visita en caso de un problema con la remisión).

Debemos recibir estos formularios tres (3) días antes de su visita.

Financing

alphaeon credit
Click Logo Above For More Information.
CareCredit Tag RGB R
Click Logo Above For More Information.