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Registration Forms:
Print out the registration forms prior to your first
appointment and complete at your own leisurely time. Please
bring this packet with
you on your first appointment with your driver’s license and
medical insurance
cards. Please don’t forget to bring this packet on your
first appointment or you will
be required to complete it all over again.
Patient Information Form: Please complete to the best
of your knowledge your personal information, insurance and
billing responsibility and your preference of where to
contact you about your lab work and test results.
Medical Records Release: If you have seen any
doctors, specialists or other healthcare practitioners, this
release gives us permission to obtain your medical records.
Financial Policy: Please read over our office
Financial Policy and sign where it asks for your signature
after you have read over our Financial Policy.
History & Physical: This detailed background health
questionnaire gives us important information about your
health history and current healthcare needs.
Privacy Practices: Review of your patient rights.
Remember to bring all completed forms to your first
appointment! If you have any questions, feel free to put
those aside until you come into the office in person.
Update Form: Our office routinely updates patient
records once every year to
ensure that we have accurate address, phone numbers and
insurance information.
We appreciate your help in keeping our records current!
History & Physical Update Form: For adults ages 18 and up. Complete
this detailed health questionnaire once a year when no more
than a week before you are scheduled for your annual
physical exam.
Child Sports History & Physical Form: Extensive health
questionnaire for students under the age of 18 who are
completing a School Physical to be released for sports or
other extra curricular activities.
Patient Feedback Form: Tell us your thoughts and feedback
on how we are
doing! Complete this short form and mail or bring in to the
office during our office
hours. |
