Patient Forms

While we try to be as paperless as possible, there are certain standard forms that are required by law.

While these forms will be available upon arrival for your first visit, many of our patients find it more convenient to fill them out before they arrive.

Please feel free to print these forms in advance and bring them with you to your first appointment.

New Patient Packet

This provides basic information on the patient and their partner, including a request for insurance information and emergency contact. We also include a “Patient Financial Responsibility” form authorizing us to receive payment for services from you and your insurance company.

HIPPA Notice of Privacy Practices

We take the privacy our patients and their medical history very seriously and always act within HIPAA (Health Insurance Portability and Accountability Act) guidelines. This form serves to inform you of your rights, and provides us to work with your medical records in accordance with HIPAA best practices.

Request for Release of Medical Records

This form gives us permission to request medical records from another physician who may have results related to our recommended care and treatment plan. If you have had testing done prior to your first patient appointment, then we advise that you request these records be sent to us before your appointment so that they can be reviewed. This allows us to use the time at your appointment more efficiently.