Patient Forms & Policies

Patient Forms

External link opens in new tab or windowCompleting Fillable Forms Guide


New Patient Forms

External link opens in new tab or windowNew Patient Registration Packet - All the forms New Patients need to complete before arriving at their first appointment.


Established Patient Forms

External link opens in new tab or windowPatient Information Update - Update your contact or insurance information.

External link opens in new tab or windowAuthorization of Release of Records to our office -  Transfer your health records to our clinic from a previous doctor or hospital. 

External link opens in new tab or windowAuthorization of Release of Records from our office  - Authorize our office to transfer your record.

External link opens in new tab or windowHIPAA Acknowledgement - Release for HIPAA Information.

External link opens in new tab or windowHIPAA Notice  - HIPAA Privacy Act information.


External link opens in new tab or windowConsent for In-Office Treatment - Communicable Disease Consent and Information.

External link opens in new tab or windowControlled Substance Consent Form - Policy for Controlled Substance Medications.

External link opens in new tab or windowWell-Woman Questionnaire - Form for Well-Woman Exams.

External link opens in new tab or windowInfluenza (Flu) Consent - Consent form and questionnaire for the flu vaccine.

External link opens in new tab or windowInfluenza (Flu) Vaccine Information Sheet - CDC information sheet about the flu vaccine.

External link opens in new tab or windowWeight Management Consent Form - Policy for Weight Management Medications.

External link opens in new tab or windowHIV Blood Test Consent - Informed consent to perform HIV Testing.



Policies

Policies

External link opens in new tab or windowPayment & 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.