For Patients

Below are our new patient forms and specialty forms to submit prior to your next visit and expedite your check in process.  We look forward to participating in your care.

New Patient Process

As a new patient:

Once your appointment is booked, we create a record for you in our medical system.

  1. Complete the New Patient Information Form and Health History Forms:
    • Click the links to download and print a PDF.
    • Or fill them out in the office prior to your next appointment.

Patient Information Form

HIPAA Consent

Insurance Coverage Consent

COVID Consent

Patient Financial Consent

MIVA During COVID-19

  1. We have a patient only waiting area and are currently limiting patients and their families in the waiting room due to Covid.
  2. Upon arrival you will be greeted by our front desk staff, have your temperature taken and be asked screening questions to ensure there is no risk of bringing COVID into the clinic. (We also perform a phone screening before every visit).
  3. Our employees are expected to follow all of these rules as well to limit our risk of exposure for each other and our patients. If any patients or employees exhibit any of the CDC symptoms of COVID they will be required to stay home and self-quarantine until they can bring a negative test result or receive treatment and be symptom free before being allowed inside of the MIVA clinic.


Most of the procedures we specialize in are covered by insurance and we’ll work with your insurance provider so that there are never any surprises. You will always know exactly what is covered before you begin any type of consultation or treatment.

We accept nearly all insurance plans including Medicare/ Medicaid and will confirm in-network or out-of-network status upon booking your appointment.