Form Name
Purpose
What do I do?
Link to...
Welcome Letter
General statement of purpose
Read
Clinic Privacy Practices Policy
Clinic's use of your personal information, including your Patients' Rights
Read
Acknowledgment of Privacy Practices Policy
Acknowledment that Patient has received Clinic's Privacy Practices Policy
Sign & Return
Electronic Communications Agreement
Communications consent form
Sign & Return
COVID-19 Consent Form
Acceptance of risk associated with COVID-19
Sign & Return
New Patient Intake Form
General patient information, including personal details, medical and familial history
Sign & Return
Cancellation Policy
24-hours notice is required in order to cancel an appointment without assessing a $45 fee. Review for more details.
Sign & Return
Arbitration and Informed Consent Agreement
Binding arbitration agreement, should the situation require such remedies.
Sign & Return
Consent for Use and Disclosure
Pertaining to the use of protected health information, payment activities, and healthcare operations.
Sign & Return