Patient Forms

Save Time Before Your Visit

To help make your appointment as efficient as possible, we encourage patients to complete required forms before arriving to the office.

Completing forms ahead of time allows our team to better prepare for your visit and helps reduce wait times.

New Patient Forms

New patients should download, print, and complete the following forms prior to their first appointment:

• New Patient Registration Form

• Medical History Questionnaire

• HIPAA Privacy Notice & Acknowledgment

• Insurance & Financial Policy

Please bring your completed forms with you to your appointment.

Established Patient Forms

For your convenience, additional forms may be available for established patients, including:

• Medical record release forms

• Updated health history forms

• Consent forms

How to Submit Your Forms

You may:

• Bring completed forms with you to your appointment

• Arrive 15 minutes early to complete forms in the office

If you have difficulty downloading or printing forms, please contact our office and we will be happy to assist you.

P

lease download, print, and complete the applicable forms prior to your appointment.

📝 New Patient Application Form

Required for all new patients

➡️ Download New Patient Application Form (PDF)

🩺 Medical History Questionnaire

Helps us better understand your health background

➡️ Download Medical History Form (PDF)

🔒 HIPAA Privacy Notice & Acknowledgment

Required acknowledgment of privacy practices

➡️ Download HIPAA Privacy Form (PDF)

💳 Insurance & Financial Policy

Outlines billing, insurance, and payment policies

➡️ Download Insurance & Financial Policy (PDF)

📄 Medical Records Release Form

For requesting or transferring medical records

➡️ Download Medical Records Release Form (PDF)

Helpful Note (Optional – Recommended)

You may bring completed forms to your appointment or arrive 15 minutes early to complete them in the office. If you have difficulty downloading or printing forms, please contact our office for assistance.

📞 Phone: (336) 677-1100