Online Forms

For your convenience, you may download, print, and fill out the following documents for your first visit:

1. Patient Registration Form

2. Consent for Treatment

3. Notice of Privacy Practices

4. Medical Records Request from your previous doctor to transfer to Pure Health.

5. Medical Records Request for your records at Pure Health

*Please note PhotoStat handles all Medical Records Requests to Pure Health and has a fee associated with it.

Testimonial

We like making people smile

  • My doctor visit was excellent. I was seen right away and she was very professional. Dr. Chasmawala explained to me in a sense that was very understandable. Yes, I would recommend in the future.

    By Robert A.

  • I am grateful for the personal and caring way Dr. C has always dealt with me and my family. I’m off a lot of my meds and I feel better than I have in years. She spends as much time with me as I need and I feel I have a better understanding of my health issues.

    By Randy T

  • I was pleased with my appointment. Dr. Chasmawala gave me good suggestions on how to solve my immediate problem and also discussed with me how to handle long term needs so they don't become long term problems. I was very satisfied.

    By John C

  • I am always rather uneasy when visiting a doctor, but Dr. Chasmawala and her staff made my uneasiness dissolve.

    By Kevin O