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PATIENT FORMS

Authorization for Release of Information
Consent for Treatment
Immediate Family Cardiovascular History
Past Medical History and Social History Questions
Patient Information Form
HIPAA Privacy Consent Form
Patient Notice of Privacy Practices
Recent or Current Symptoms Question
Patient Consent Form for Disclosure of Health Information

**New Patients:
  • Please complete the above forms prior to your appointment. Arrive 20 minutes prior to your appointment time so that our Front Desk and Medical Assistant can do preliminary work-up in preparation to your visit with our Doctor. Items that we ask that you bring to your appointment are as follows: 1) Insurance Card(s) 2) Picture ID 3) ALL prescription medications and ALL over-the-counter medication bottles 4) Completed patient information forms.
  • Please be aware if your insurance requires a referral; it is your responsibility to inform your Primary Care Physician’s office that you will need a referral prior to your appointment with our Doctor.



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