To expedite your first visit please print and fill out the the following form package:
The forms included in this download is needed for all patients. Please print this document, fill it out completely and bring it with you on your visit.
- The Patient Registration form.
- Our ‘Notice of Privacy Practices’ and is required by law that all patients review it and sign the acknowledgement form.
- The Medical History form is extremely helpful for us to know your complete medical history.
- Medical Release form is needed for all patients where we will need to request your medical records form a previous physician.
- Our Financial Policy document explains our financial policy completely.
- The Authorization for Protected Health Information is need for each individual’s authorization to disclose their health information to any other organization.
- Our Payment/Credit Card Authorization form is required by the business office to document payment authorization.
Please call (386) 423-2550 to find out more about our practice and to schedule an appointment.