New Patient Forms
Please complete these forms and either send them in prior to your first appointment, or bring them with you.
Go to a printable page!
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
