Below are forms that you may need for your appointment. Please call our office or see the guidelines below if you are unsure what forms you will need.
Patient Forms
Visit Information:
For every appoint please bring the following:
- Insurance Card
- Photo ID
- Updated Medicine List- You may bring all bottles or a list that includes, Name of Medicine – Dosage – Frequency - Please include all over the counter and vitamin supplements.
- Copay- If you are unsure of your copay, please contact your insurance provider. Every plan is different.
Annual / Any appointment one year or more since your last visit.
- If it has been a year or more, you will need to complete the HIPAA form as well as the payment agreement form.
New Patients:
- All of the above
- Completed forms: New Patient Registration, Medical Health History, Payment Agreement and HIPAA
- A nurse will contact you before your appointment. This is to obtain your medical history prior to your appointment, allowing you more time to spend with the provider. This must be completed, or your appointment will need to be rescheduled to a later date.
- Please arrive 15 Minutes Prior to your appointment.
OB Patients:
- Please follow all the above guidelines.
- Please include additional forms: OB History form, New OB Ultrasound Form
Minors:
- Please include additional form: Minor Consent Form
- A parent or Legal Guardian must come to the first appointment, and any other appointment that would require a procedure.
Medicare:
- If you over the age of 65 and have Medicare please include the ABN medical form.