Dear New Patient,
We are pleased to welcome you as a new patient to our practice. One of the most important decisions in life you will make is the physician you choose to care for you in sickness and health. Therefore, we truly appreciate the trust you have placed in us and promise to care for you to the best of our ability.
In order to provide the highest quality care for you, it is essential that we obtain accurate data and copies of any pertinent past medical records. We ask that you download and complete the following forms. To expedite your initial appointment, please fax or mail your forms to our office prior to your appointment. Our staff is always willing to answer any questions you may have regarding completion of these forms. If you are unable to download these forms, please call our office and we will mail you a new patient packet.
Please allow up to two hours for your initial appointment as this will include review and completion of these forms and possibly a complete physical exam depending on what is mutually decided between you and your physician. We kindly ask you to bring your insurance cards and copay (if applicable) to each visit. The annual subscription fee and completion of a Physician-Patient Agreement will be collected prior to your first appointment.
Please access and complete each form below prior to your first appointment:
Consent for the Use or Disclosure of Protected Health Information
Advance Beneficiary Notice (ABN)
(To be completed by Medicare Patients Only)