Annual Update Forms

At the beginning of each calendar year, we ask all established patients to the practice to complete or updated a set of the following forms. While them may seem redundant (and annoying) we have learned after 25 years that collecting accurate and verified information each year assists in providing our patients with personalized and seamless care.

Patient Information form: provides our practice with your specific identification information and informs you of our office policies

HIPPA form: designates where and to whom our office may communicate or leave messages

Insurance release form: gives permission for communication with your insurance company for payment of services

Consent to Use and Disclose Health Information form:  gives the practice permission to disclose your information to your insurance company for the purposes of payment for services rendered.

Records Release form: gives permission to request copies of the medical records for care received at another facility or from another physician

 

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