New Patient Forms

Covid Pre-Screen

Your health and safety always rank #1 with us.

You’ll notice a few differences when you visit, but the care you receive won’t be one of them. Here are a few things you’ll see:

  • We will use no-touch mobile communications such as text, email and phone.
  • We will ask you to wait in your car and text us upon arrival.
  • Hand sanitizer is readily available.
  • Temperature checks help us screen everyone.
  • We’re using some new protective gear.
  • If you’re not feeling well, we can help you reschedule.

There are also a few things behind the scenes that might not stand out. Just a few include:

  • Added cleaning and disinfection of public spaces.
  • Continued strict sterilization monitoring.
  • More training than required on protective measures

Did we mention that we’re excited to see you? But before we do, please take a minute to fill out the pre-appointment screening and health history forms by clicking below! Thank you.

Authorizations and Acknowledgements

ACKNOWLEDGEMENT OF PRIVACY PRACTICES AND CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION

Private Practices: I (the patient) have the right to read the Privacy Practices. A copy of the Notice and/or this consent is available upon request and anytime on our website. The Notice provides a description of our practice's treatment, payment activities, healthcare operations and the uses and disclosures we make of your protected health information.

Purpose of Consent: I (the patient) understand and consent to the use and disclosure of my protected health information to carry out treatment, payment activities, and healthcare operations.

Personal protected information cannot be shared with anyone unless otherwise allowed by HIPAA rules.

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