Patient Information

Patient Forms & Information


Please print out the patient information forms on this page.  Have these forms completed upon arrival to our office for your appointment.  Please note that we require a photo ID of all adult patients.  If the patient is a child we do require a photo ID of the parent or legal guardian.  If you are a legal guardian we will need proof of legal guardianship.  We also require a copy of your insurance card upon checking in at our front desk.  All children under age 18 must be accompanied by a parent or legal guardian.

We collect all co-pays at the time of service.  If you have a deductible policy we do collect a deposit of $75.00 at the time of your appointment which will be applied to your charges.  You will be balance billed for the remaining balance which is to be paid within 30 days.

Please come prepared with knowing why you are seeing the physician as well as a history of your present illness.  If you have had testing or scans at a different location please bring the reports with you.  It is helpful to bring with you a list of all your current medications that you are currently taking including over the counter medications and vitamins. 

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Please have these forms completed before arrival to your appointment:
 Patient Information Form
 Release of Records Form
 Privacy Notice 2014