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WEB Current Patient Request Document - v2

Page One

The completed form will be emailed to a clinician at Gateway. As with all electronic communications, email is inherently insecure. If you want to guarantee the security of your message, please install a secure email service, like Virtru, and email our office manager directly at
This form is for requesting a copy of a document. For other questions please go back to the GPS home page and select "Online Office" and then "Current Patient" and then the appropriate option.
Contact information
This question requires a valid email address.
If you want a phone answer it may be a few hours before I call you.