Become a Patient

Become a New Patient

We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:

  1. Make an Appointment
  2. Sign up for our patient portal
  3. Download your patient forms online through the patient portal

When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.

To make sure there are no delays in care during your first visit experience, please arrive 15 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.

Remember to bring:

  • Your insurance card
  • Valid photo ID
  • List of current medications
  • Office co-pay

In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.

For patients who are delayed and arrive late for appointment, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled.

Patient Forms

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. AutorizaciĆ³n y Consentimiento Para el Tratamiento

Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Office Policies

Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

HIPAA Privacy Notice

Privacy & License Policy

If you consent, Locust Grove and Reliance Family is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment and applying for future care or treatment. It also includes billing documents for those services.

When you come into the office, you will receive a privacy agreement that is filled with information that explains the circumstances that we may use your information. We do not use your information for anything other than medical (information) or reimbursement purposes. You will also receive a paper that instructs us on who is allowed to receive your personal medical results.

The Information obtained on this website is for our office use only. Unless you have signed the privacy agreements that you receive when you become a patient of Dr. Trivedi’s your information will not leave our office.

Here is a PDF copy of the two privacy releases you sign when you become a patient. If you’d like you are welcome to print them out and bring them (pre-filled) to the office when you come in.

HIPAA Acknowledgement Consent Form

Patient Medical Records Release Form

If you are already a patient, unless requested you will not need to sign these forms again.