CURRENTLY NOT ACCEPTING NEW PATIENTS
NEW PATIENT QUESTIONNAIRE
Please download, print and complete the new patient questionnaire prior to our first visit. This will allow you the opportunity to take your time filling out the forms at your convenience. Also ensuring you have not left any information out. Please include a copy of your Insurance card(s) when returning the New Patient Questionnaire. The Receptionist can make a copy for you, if needed.
New Patient Questionnaire Forms
Adult Form:
| adult_new_patient.pdf |
Child Form:
| child_new_patient.pdf |
Release of Infomration (HIPPA)
Use this form if we are getting records from other providers. Fill out one form for each provider.
| roi.pdf |
LETTER TO NEW PATIENTS
This letter will help you understand my office procedures, policies, what you can expect from me, and your responsibilities to my office.
Letter to New Patients:
| julie_lettertonewpatients.pdf |
