Patient Forms & Policies
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.
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.