Patient Resources & Information

For your convenience, we have downloadable new patient forms.

These forms have been designed to make your process of registering for an appointment as easy as possible. Each form has two versions. One version allows you to download the form to your computer, complete it at your convenience right on your computer, print it at home, and then bring it with you when arriving for your appointment. See downlaodable forms below.

Existing Patients

This secure link requires that you have received an invitation email to set up an account can access this site. Patient's who do not have an email invitation cannot set up access through the portal. Please call our office during normal business hours to request a Portal invitation.

Worried you might forget your forms? The second version moves you to a secure web site, then allows you to complete the form online and submit it immediately and directly to us in a safely encrypted format.

Online Secure Patient Portal

We will need the following forms for your appointment:

  • Patient Demographic Form. This form provides the most basic information about you, the patient, and your insurance so that we can create an account for you and bill your insurance.

New Patient Registration Form (PDF)

  • A Listing of the Medications You are Taking. The simplest way to create this list is to gather all of the vitamins, pills and medication bottles that you are taking daily. Then, with the bottles in front of you, you can complete this listing.
  • HIPAA Acknowledgement Form. The Federal government requires us to provide you with an explanation of our health information disclosure policies as mandated by the Health Insurance Portability and Accountability Act (HIPAA). When printing this acknowledgement form, you will also receive a copy of our policies. For more information on the federal HIPAA guidelines, click here

HIPAA Privacy Practices Notice (PDF)

  • Financial Responsibility and Release Form. This document explains your responsibilities for payment on services rendered, how insurance claims will be submitted on your behalf, and assigns benefits for insurance claims to be paid to us directly.
  • Patient Interview Form. This document asks numerous background questions relating to your medical history, covering current and past conditions, surgeries and various situations in your social history.
  • A copy of your current insurance cards and driver’s license.

Patient Interview Form (PDF)

 

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