sitting-human-woman-workplace-paper.jpg

PATIENT FORMS

NEW PATIENT FORMS

Nurse Talking to Patient

NEW PATIENTS ONLY

Prior to your first appointment, please download, complete and bring with you the following PDF forms. These forms can be filled out on your computer by opening them in Adobe Reader (Please click the Adobe icon to download the program for free).

Signature

NEW PATIENTS ONLY

Prior to your first appointment, please download, complete and bring with you the following PDF forms. These forms can be filled out on your computer by opening them in Adobe Reader (Please click the Adobe icon to download the program for free).

Credit Card

NEW PATIENTS ONLY

It is important that we have good understanding with our patients regarding financial responsibility.  We hope this summary will be helpful toward that end. We encourage you to discuss it with us and ask questions if necessary.

ALL PATIENT FORMS

Doctor with Files

FOR ALL PATIENTS

Authorization for use and disclosure of protected health information.  All Medical Records are processed by an outside company (Vital Records). If you need medical records, then please request in writing and allow 7 -10 business days for this to be processed.

Contract Review

FOR ALL PATIENTS

This Notice of Privacy Practices (the “Notice”) tells you about the ways we may use and disclose your protected health information (“medical information”) and your rights and our obligations regarding the use and disclosure of your medical information.