29 hours ago May 22, 2015 · Sign up for our patient portal; Download your patient forms online through the patient portal; When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment. >> Go To The Portal
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May 22, 2015 · Sign up for our patient portal; Download your patient forms online through the patient portal; When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.
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Patient Forms. Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente. Authorization and Consent for Treatment (PDF) - All patients must provide their ...
9/12/2018 New Patient Request Form Name: _____ Preferred Name (if different): _____ Address: _____ City/State/Zip: _____
Patients who are coming for a Medicare Wellness Exam should complete this form and bring it with them to their appointment.
Patients who are new to our Employer Direct Primary Care program should complete this form and bring it with them to their first appointment along with their photo ID, DPC member card, insurance card, and any prescriptions, over-the-counter medications, vitamins and supplements they are taking.
Patients who are coming for an ultrasound should review this form in advance, as certain exams require specific preparations.
This form is used to ask one of our offices to send your records to another one of our offices.
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.