Patient Policies & Forms

Here you will find some of the more typical forms used within our office as part of maintaining your health records, insurance, and billing information.

 

These forms are in Adobe Acrobat Reader format. The Adobe Acrobat Reader is free and is installed on most new computers. If you don't have the Acrobat Reader, please visit Adobe to download it. Once the Reader is functional, please print the necessary forms, complete them, and remember to bring them with you during your office visit. This will speed our ability to serve you.

 

All Patients who would like to pre-register please click on and print out all appropriate forms and bring them with you along with your insurance card and drivers license to your appointment.

 

All OB patients must talk to our insurance person before coming in for appointment.

 

General Patient Forms:

HIPPA:

Records Release:

 

    • Prescription call in fee $20
    • Prescription Authorization $20
    • After Hour Phone Calls $20
    • Filling out FMLA/Disability forms - 1st form $30 & any additional forms $15
    • Return Check Fee $30
    • Failure to keep appointments or being non-compliant can be subject to dismissal from practice.