New Patient Forms

Please fill out the following four (4) forms to complete your new patient paperwork. Once the forms are complete, you can upload and submit them through the form below.

Patient / Responsible Party Information
Patient Medical History
Release of Information to Highlands Oncology
Release of Information from Highlands Oncology

Submit New Patient Forms

Name(Required)
MM slash DD slash YYYY
Drop files here or
Max. file size: 50 MB.