Contact – FORMS

*Note*  If you hold the Control Key down while clicking on the relevant forms with your mouse, you will open a new tab in (most) browsers that you can save to disk and fill out.  

Commercial Insurance: 
Authorization to Release Information
Health History Questionnaire
Medication List
Office Cancellation Policy
Patient Registration 
TeleMED Consent revised

Medicare:  
Authorization to Release Information
Health History Questionnaire
Medicare Questionnaire 2021-2022
Office Cancellation Policy
Patient Registration
TeleMED Consent revised

Note – These forms can be downloaded and printed using any Browser that supports PDF, and then scanned, emailed or mailed as you prefer.

However, if you wish to fill them out electronically, use Adobe Acrobat Reader or a similar package.  Internet Explorer, Chrome and other browsers generally do not draw and allow editing correctly.

(0efbH – 20210609)