Rostami Circle

The new Rostami Circle Membership Program entitles Members to the benefits and special pricing as provided on the office Rostami Circle Discount Card.

Simply click on the links below.

Please print and complete each of the forms. You may either bring them with you to your initial visit, or you may fax them to our office.

• Rostami Circle Form

• Disclamer Form

• Patient Registration (Mandatory for all patients)

• Patient History (Mandatory for all patients)

• Credit Card Authorization (Mandatory for all patients)

Adobe Acrobat Reader is required to view PDF files. This is a free program available from the Adobe web site. Follow the download directions on the Adobe web site to get your copy of Adobe Acrobat Reader.