value. quality care. convenience

 

NEW PATIENT

MEDICAL RELEASE

FINANCIAL POLICY

New Patient Registration Form - Required for all new patients. This form allows us to register you into our practice as well as provides us with a brief medical history of any problems you may be experiencing. Also attached is a copy of our privacy practices.

Medical Records Release Form - Authorizes us to release your medical records to an individual or another doctor's office.

Financial Policy and Insurance Requirements - Information related to established policies within our practice.

 

CREDIT CARDS

COUMADIN CONSENT

DIAGNOSTICS INSTRUCTIONS

Credit Card Pre-Authorization Form - Required to authorize recurring credit card charges or standard payments to the clinic.

Consent for Warfarin (Coumadin®) Educational Material and Consent Form.

NST Instruction Sheet - Important instructions that must be signed and returned to the clinic prior to any Nuclear Stress Test.

 

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