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New Patient Forms

In an Effort to Go Green and comply with the 2012 Electronic Medical Records Act, we ask that you assist us and please download, print, and fill out your New Patient Forms prior to coming in for your first office visit.
 
We will still need a copy of your insurance card, drivers license, and/or claim number. 
 
When you arrive at our office we will need to have you sign a copy of your insurance assignment of benefits and HIPPA forms.
 
Thank you for your assistance in help to making our office a Greenier Work Environment.
 
We look forward to seeing you at your first visit!
Ċ AutoAccidentForms.pdf
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Auto Accident New Patient Forms. Please fill out prior to your first office visit. Remember to bring in a copy of your Accident Report & Insurance Claim Number.  165k v. 1 May 14, 2010, 11:18 AM Damon DeWeese
Ċ HealthInsuranceForms.pdf
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Health Insurance New Patient Forms. Please fill out prior to coming in for your first visit. Remember to bring in a copy of your Insurance Card & Drivers License.  106k v. 1 May 14, 2010, 11:19 AM Damon DeWeese
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