Office Forms
This page will allow you to download office forms (as .pdf files) that can be faxed or brought into the office when those life changes happen. Patient registration forms (page 1 - information only on name and contact information; page 2 - insurance information and authorization for billing signature), a medical history questionnaire, office policies, vaccine refusal, and medical record transfer requests are available. Also referral and prescription requests are listed as well. Honestly, we have done as much as possible to limit the number and length of the forms we ask of you, despite the ever increasing regulatory and insurance demands.
Please click on the desired form to the right and (hopefully) a current version of the document will open in a new browser window. The forms are not editable online at this time, but can be printed and completed by hand or typed, then faxed to the office as needed. Please include a photocopy of the current insurance card (front and back) if you are faxing the Patient Registration form or Referral Request with new insurance information.
Since our web host is not on a secure site, emailing or sending personal data by electronic means other than fax are restricted by privacy regulations.
If you have any questions about which are the appropriate forms to use or difficulty completing the documents for any reason, please contact the office directly so that we can assist you.