PATIENT FORMS
Providing secure online patient registration and consent forms is just one more way we strive to provide the highest quality of care, convenience and comfort for our patients. We believe your time and your privacy matters. In order to maximize your time in our office and eliminate in-office waiting, please complete the forms indicated by our staff prior to your upcoming appointment. If you have any questions, please do not hesitate to call our office.
We look forward to seeing you soon!
You MUST complete and submit FORMS 1-4 prior to arriving at our office for your appointment.
If you are 65 or over OR if you have Medicare for any other reason, you MUST also complete form #5.
PATIENT FORMS - ENGLISH
0.1 Patient Information
0.2 Health History
0.3 HIPAA Notice & Acknowledgement
0.4 Controlled Substances
0.5 Medicare Private Contract*
FORMULARIO DEL PACIENTE - ESPAÑOL
0.1 Informacion del Paciente
0.2 Historia Medica
0.3 HIPAA (Aviso de normas de las agencias de salud y servicios humanos sobre la privacidad)
0.4 Sustancias Controladas
0.5 Contrato Privado de Medicare*
*Medicare Private Contract Form is mandatory ONLY for those 65 or over or those who have Medicare for other reasons.
IN ADDITION TO COMPLETING ALL YOUR NEW PATIENT FORMS, EVERY PATIENT MUST COMPLETE A COVID-19 SCREENING FORM PRIOR TO ANY APPOINTMENT. DUE TO COVID-19, YOU WILL NOT BE ALLOWED IN THE OFFICE UNLESS ALL FORMS HAVE BEEN COMPLETED AND RECEIVED BY OUR STAFF.