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Form Information |
( Download These Forms ) |
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Complete Your Medical Forms in Advance |
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When you visit us for the first time, we will need some information form you. |
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The more we know about your medical history, the better able we will be to treat you effectively. |
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We will also need to know about your insurance coverage and how to reach you. |
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As Simple As 1-2-3: |
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It's a very simple process. |
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1. Simply click on the form that you need in the "FORMS" section
below
2. After it has loaded, you have two options:
A. Print the form and then fill it out by hand, or
B. Complete the form On-line and then print it out.
3. Sign where appropriate. |
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PLEASE NOTE: You will need the Adobe® Acrobat® Reader program installed on your
computer to complete this task. It is available for FREE from the Adobe® web site at this link. |
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Forms: |
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When you visit us for the first time, we must ask you to fill
out some forms. In order to reduce your registration time, we have made these forms
available by following the simple steps below. You can fill the out in the comfort
of your home and bring them with you to your appointment
In addition, you will need to bring your insurance card or cards
and photo identification.
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Personal Medication Record: ( Click here for download )
It is very important for us to know about the medications you
are taking. |
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General Patient Information Form:
This enables us to submit claims to your insurance carrier on
your behalf. It also tells us how to reach you, your privacy preferences and emergency
contact information. |
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This form may be printed and then completed by hand and brought to the office. |
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Download Now! |
43KB
Download time
@ 28.8Kbs ~ 19 sec. |
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The form may also be competed on the computer using Adobe® Acrobat® Reader 5.0 (or
greater) then printed and brought to the office on your first appointment. |
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Download Now! |
43KB
Download time
@ 28.8Kbs ~ 19 sec. |
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Health History Form:
(It is only necessary to choose one option.)
This vital information helps the doctors become familiar with
your personal and family medical history. The more we know about your medical history,
the better able we will be to treat you effectively. |
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This form may be printed and then completed by hand and brought to the office on
your first visit. |
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Download
Now! |
38KB
Download time
@ 28.8Kbs ~ 15 sec. |
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The form may also be competed on the computer using Adobe® Acrobat® Reader 5.0 (or
greater) then printed and brought to the office on your first appointment. |
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Download
Now! |
493KB
Download time
@ 28.8Kbs ~ 172 sec.
(3.5 min) |
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Pediatric Information Form:
(It is only necessary to choose one option.)
This form gives us essential information regarding your child’s
health history. |
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The form may be printed and then completed by hand and brought to the office prior
on your visit. |
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Download Now! |
16KB
Download time
@ 28.8Kbs ~ 7 sec. |
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The form may also be competed on the computer using Adobe® Acrobat® Reader 5.0 (or
greater) then printed and brought to the office on your first appointment. |
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Download Now! |
493KB
74KB
Download time
@ 28.8Kbs ~ 30 sec. |
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