Office Forms
If you wish, you may download these forms prior to visiting our office. These forms are in PDF format. You will need Adobe Acrobat Reader - a free document viewer.

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Required for your first visit:

Patient Registration Form - Personal and insurance information.
Patient History Form - Personal and family medical history.

Addtional Forms:

These forms may be downloaded and filled out prior to your visit in order to speed up your check-in process.

CGHE Permission Form - Permission to create a Health Exchange Record and share medical information with healthcare providers.
Patient Demographic Form - Patient, primary care physician, and emergency contact information.
Patient Consent Form - Permission for us to use r disclose information about yourself for the sole purpose of your treatment (optional).
Assignment of Benefits & Release of Financial Information Form - Authorization of payment for insurance benefits
Authorization for Release of Information and Assignment of Benefits - Your authorization to release medical information for the purpose of filing an insurance claim.
Patient Permission Form - Consent and permission for physicians and staff to perscribe and perform treatments and tests recommended for your health needs.

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