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New Patient Forms |
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Please complete these forms and either send them in prior to your first appointment, or bring them with you.
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Related Documents:
- Patient Contact Policy.pdf
Tells me how you wish me to contact you or leave messages. - Waiver for Billing Medicare.pdf
Must be completed prior to me seeing a person with Medicare as primary insurance. - Auth to Release Healthcare Information in.pdf
Form to request medical records from your previous provider(s). - HIPPAAcknot of Receipt of Notice of Priv Pract.pdf
Acknowledgement of Receipt of Notice of Privacy Practices - Patient Billing Agreement1.pdf
Explains our billing agreement. - Pinnacle Credit Card Auth.pdf
Authorization for keeping a credit card on file