New and transferring patients! Save time at patient check-in by filling out the following three forms before your appointment. You can fill them out on your computer, then print them out to bring to your first appointment. You may also print the forms to fill out later by hand if you wish. (*Note: Adobe® Reader is required to open and fill out these forms. Free for Mac or PC at Adobe.com)
(1) Patient Intake Form: Please fill-out this intake form if you have not submitted one through the appointment scheduling portal: Patient Registration Form
(2) Patient Privacy Policy: In keeping with the patient privacy standards set forth by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we have established our HIPAA Notice of Privacy Practices document which can be read here. After reading this document, please fill in and print our HIPAA Acknowledgement Form to bring with you to your appointment.
(3) Transferring Your Medical Records: Use our Authorized Request for Release of Protected Health Information (PHI) form to request transfer of your medical records from another physician or medical center. After you fill in and print out this form, you can fax or bring it to your current physician to have your records transferred to our practice. There may be a fee for this. For more information about transferring medical records, read this article in our blog.
(4) Missed Appointment Policy: Use this link to our Missed Appointment Policy Acknowledgement form. All patients must agree to the terms of this policy regarding missed, or late rescheduled/cancelled appointments.
