Patient Registration Made Easy!

After you print the form, click the “back” button on your browser to get back to this page.

Click Here to Print the Pediatric Form

Click Here to Print the Adult (over 18) Form

Click Here To Print the AVVDA Patient Screening Form

Having a problem reading the form?

Our Information sheets are in .pdf format which is viewable with the “Acrobat Reader Plug-in”. Most newer computers come with this plug-in already installed. If your computer doesn’t have the “Acrobat Reader Plug-in” or you’re not sure, simply click on the yellow box below and visit Adobe’s Web site. From there you can download the plug-in free of charge.