NEW Patient
DEMOGRAPHICS
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This document requires demographics information, emergency contact, and insurance information to help us communicate and coordinate your care.
MEDICAL HISTORY
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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
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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
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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
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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.
SELF PAY
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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.