Patient Forms
In order for us to help you we need some information from you. We agree that filling out forms is tedious, but we hope by making them available to you on-line, it will make your first visit with us more pleasant. Click on the subheads below to download the forms in pdf format.
Admissions Form
Please download the Admissions form and fill out completely and fax it to us. If you have a prescription from your doctor please fax that too. Please fill out the insurance section completely so that we can research your benefits for you prior to your first visit.
Notice of Privacy Practices (2 pages)
We have included information about our privacy practices. Please download the information and read.
Patient Authorization Form
This form serves many purposes. Please download the authorization form. Once you have read and signed the form please fax it to us. By signing this form you are agreeing to the following:
- Treatment and the release of information as it relates to your treatment.
- Confirming receipt of the Privacy Practices
- Assigning of insurance benefits
- Guaranteeing payment
Medical History
Obtaining a thorough medical history is important in the care of any patient. Please download the form, fill it out completely and fax it to us, or bring it to your first appointment.
Cancellation Policy
Please download the policy, review it and sign. You may fax it to us or bring it with you to your first appointment. |
