NEW Patient
DEMOGRAPHICS
New patients
Established patient if any changes
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This document requires demographics information, emergency contact, and insurance information to help us communicate and coordinate your care.
MEDICAL HISTORY
New patients
Established patient if any changes
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This document requires current information about your office visit and past and present medical and surgical history.
NOTICE OF PRIVACY PRACTICE
READ
New patients
Established patient
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This notice describes how medical information about you, or your family member may be used and disclosed and how you can get access to this information.
ACKNOWLEDGMENT
New patients
Established patient
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This document requires your signature to verify that you have read the Notice of Privacy Practices.
FINANCIAL POLICY
INSURANCE BASED PAYMENTS and self pays
New patients
Established patient (if your insurance status has changed)
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This document has been put in place to ensure that financial payments due are recoverd to allow us to continue to provide medical care for our patients.