Patient Forms & Policies

Patient Forms

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 - Authorize our office to transfer your record.

HIPAA Acknowledgement - Release for HIPAA Information.

HIPAA Notice  - HIPAA Privacy Act information.


Policies

Policies

Patient Policies - Information regarding Appointments, Laboratory Results, Medication Refills, Narcotics, Referrals, Returned Calls and more. All patients are required to sign.

Payment Policy - Information on Patient Payments, such as co-pays & deductibles, Insurance Payments, Appointment Cancellation fee, Billing, & Delinquent Accounts. All patients are required to sign.