You may print, fill out, sign and bring in the appropriate forms to your appointment. The Registration form and HIPAA Contact Preference form are required for ALL patients and on a yearly basis. For patients coming in for a complete physical, please note the forms are different for existing versus new patients.
Practical Information for our Patients HIPAA Contact Preference Form - required for ALL new patients and existing patients(once per year) Existing Patient History Review Form - required for all existing patients coming in for a complete physical, preoperative examination, or for those who have not been seen in over a year. New Patient History Review Form - required for all new patients except those coming in for immigration or FAA examinations unless otherwise informed to do so by office staff. Medicare Health Risk Assessment (HRA) Page 1 form, Page 2 Form, Page 3 Form - for the "Welcome to Medicare" exam AND Medicare's "Annual Wellness Visit" (AWV) Medicare Letter - letter to Medicare patients (2/24/11) about the changes to care/visits, etc... based on The Affordable Care Act (ACA) of 2010. Patient Portal Authorization Form eMD Patient Portal Instructions Survey - (let us know how we are doing) |