Office Forms and Disclosures

Forms About Us

This is the welcoming document included in our patient packet. Please read it before any appointments because it has instructions on what forms we need you to fill out before coming to the office. Contact information and directions are also included.

HIPAA Notice of Privacy Practices (Word document)

This document outlines how your medical information may be used or disclosed. It also explains how you can access your personal medical information. Please read and review this so that you understand your privacy rights.

Patient Financial Policy (pdf)

This explains our policies regarding payments, including your exact financial responsibilities. You must read and sign this before your appointment.

Forms About You

Patient Demographics Sheet (pdf)

This is a standard form asking about basic information such as your name and address. We need you to fill out this form and have it ready when you come to the office for an appointment.

Patient History Sheet (pdf)

This form asks for more detailed information on your medical history. We also need you to fill out this form before you come to the office for your appointment.