Patient Forms & Policies

Patient Forms

Completing Fillable Forms Guide


New Patient Forms

New Patient Registration Packet - All the forms New Patients need to complete before arriving at their first appointment.


Established Patient Forms

Patient Information Update - Update your contact or insurance information.

Authorization of Release of Records to our office -  Transfer your health records to our clinic from a previous doctor or hospital. 

Authorization of Release of Records from our office  - Authorize our office to transfer your record.

HIPAA Acknowledgement - Release for HIPAA Information.

HIPAA Notice  - HIPAA Privacy Act information.


Consent for In-Office Treatment - Communicable Disease Consent and Information.

Controlled Substance Consent Form - Policy for Controlled Substance Medications.

Well-Woman Questionnaire - Form for Well-Woman Exams.

Influenza (Flu) Consent - Consent form and questionnaire for the flu vaccine.

Influenza (Flu) Vaccine Information Sheet - CDC information sheet about the flu vaccine.


Policies

Policies

Payment & Patient Policies - Information regarding Patient Payments, such as co-pays & deductibles, Insurance Payments, Appointment Cancellation fee, Billing, & Delinquent Accounts.  Information regarding Appointments, Laboratory Results, Medication Refills, Narcotics, Referrals, Returned Calls and more. All patients are required to sign.