Forms for NEW Patients
NEW PATIENTS: When granted access, please log on to your Patient Portal to sign all new patient forms including :
- New patient letter – mandatory for all new patients, It explains our services, company rules, consent to treat, etc. Please read over it carefully as we do expect all patients to understand and agree to the terms.
- Medicare private contract – mandatory for all patients above 65 years old or if you have Medicare for any reason. We are legally not allowed to see Medicare patients if you do not sign this form. If you are Medicare-eligible but do not have Medicare, you are still required to sign. This is a federal regulation, not our rule.
- HIPAA privacy policy – all new patients.
- Copy of your driver’s license – mandatory to ensure you are who you say you are and to verify you’re in a state that we’re licensed. If you don’t have a driver’s license, then please send any photo ID and proof of current address (electric bill, etc). For minors, a parent or guardian driver’s license is sufficient.
- Copy of your insurance card – This is optional, but very helpful for prescriptions, labs, etc.
- You will also update your medications, allergies, and your medical history.
If you would like any records sent to us by another medical Provider, please fill out our Medical Release form, then print it out, and send directly to them.
Forms for FOLLOW-UP Patients
ESTABLISHED / FOLLOW-UP PATIENTS: Log on to your Patient Portal before every visit to update medications, allergies, and any changes to your medical history.
- Medicare private contract – must be signed yearly if you have Medicare and/or are 65+ years old
- HIPAA privacy policy – should be signed by all patients every 2-3 years.
- Copy of your driver’s license – If there have been any changes
- Copy of your insurance card – If there have been any changes