Decrease the time spent in our office on your initial visit by printing our forms ahead of time! You will need to print out the group of three forms for EACH family member beginning care. To print these forms, either "right click" with your mouse over the frame and click on "print," or click on the frame and go to your browser menu, click on "file" then "print."
For patients 13 years and older, there are three forms to fill out:
Initial History form, 1st page
Initial History form, 2nd page
(The following form is available for you, but does not need to be filled out. It is used in combination with the HIPAA Form) Notice of Privacy Practices
For children 12 years and under, there are also three forms to complete:
Pediatric History Form, 1st page
Pediatric History Form, 2nd page
If you were involved in a car accident fill out these following two forms for each person in the auto IN ADDITION to the three forms above. (If you had children under 12 in the auto, fill out the pediatric forms above as well).
(Do not fill out the "Work Injury" section on the form if you were involved in an auto accident)