Secure document upload

Upload completed forms

Choose a completed New Patient Form, a completed Request for Records, or both. Each PDF is submitted securely and receives its own confirmation number.

Your completed forms are protectedFiles are sent to CCDC over HTTPS, emailed through the practice’s configured secure mail service, and stored as encrypted server copies.

Choose your completed PDFs

Select either form or both. PDF files only, up to 12 MB each.

Completed New Patient FormThe signed New Patient Form PDF, including its required acknowledgements and authorizations.No file selectedCompleted Request for RecordsThe signed Request for Records PDF, including the records-transfer authorization.No file selected

Before uploading, make sure every applicable field is complete and each required signature, acknowledgement, and authorization is present.

Confirm and submit

Your confirmation applies to every PDF selected above.

I confirm that each selected form is complete, every required acknowledgement and authorization is checked, and the form is signed.

Securely submit your completed forms

You may submit one form now and return later for the other. If both are selected, each is processed separately.