New Patient Forms

At our practice, we prioritize a seamless and comprehensive experience for our new patients. As part of this process, we require the completion of several essential forms to ensure we have the necessary information to provide you with optimal care.

Form 1: Patient Registration Form 
This form collects vital demographic information, including your name, address, contact details, and emergency contact information. It also outlines our cancellation policies, ensuring you are informed about any fees that may apply in case of missed appointments. A key feature of this form is the section allowing you to designate individuals from whom you authorize our staff to discuss your medical information or leave messages, such as test results or treatment updates. It is important to note that anyone not listed on this form will not be granted access to any patient information.

 

 

Form 2: Medication List Form 
In this form, please list all medications you are currently taking, including dosages and frequency. This information is crucial for our healthcare providers to understand your current treatment regimen and to ensure your safety while receiving care.

 

 

Form 3: Patient Privacy Practices Notice 
This document outlines our commitment to your privacy and the measures we take to protect your personal health information. You will receive a copy of our Patient Privacy Practices Notice, which explains your rights regarding your medical information and how it is used within our practice. If you would like an additional copy at any time, please do not hesitate to request one.

 

 

We appreciate your cooperation in completing these forms, as they play a significant role in helping us provide you with high-quality, personalized care. Thank you for choosing our practice for your healthcare needs!