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We want to welcome you and look forward to having you visit our office.
In preparation for your visit, please complete the patient information, general consent,
and the medical history forms. Please return the completed forms to the office at the time
of your appointment. If you do not bring the forms completed,
your appointment can be delayed. Please be sure to have your
insurance cards at the time of your visit. If you need help
completing the forms, please do not hesitate to call the office,
we would be happy to help you!
Helpful information in completing your forms:
- Patient Information Form
- Please be sure to complete the entire form.
- If a patient is covered by insurance through a parent/guardian insert the parent/guardian's information in the space for spouse/partner
- If you have two insurances, the patient's insurance is primary.
- Medicare is primary to other insurances only when the patient/spouse does not have insurance through an employer.
- Please make sure the Emergency Contact Information is filled out.
- General Consent
- Be sure to write your name on the upper right hand side of the form
- Be sure to complete all shaded areas.
- Advanced Directives and Patient Rights are on the back page. At the time of your appointment, we will give you the pink and blue copy of this form to keep for your records.
- Be sure to sign and date the bottom of the form.
- Medical History Form (Page 1 and Page 2)
- Please answer all the "YES" and "NO" questions
- Fill out the family member medical information (on page 2) completely.
Thank you kindly for your cooperation and we look forward to seeing you!
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