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Office Forms

formHere are some office forms you can print out and fill in prior to your visit to save time.

Click on the colored links to download the form to print it out.


Patient Registration Form (page 1) (page 2) – This will gives us all the info we need to contact you, like address, phone number, etc. as well as insurance info.

HIPAA – Here is the form that the government makes everyone sign about health care privacy rules. If you want to read the whole set of rules, click here.

Health History Form – This is a form on which you can summarize any significant family history of any illnesses that might be important for us to know.

Medicaid Agreement – If you have a new baby, and you will be applying for Medicaid, please read and sign this agreement.

Transfer Records In – Here is the form to print out to give to your old doctor giving them permission to send us your child’s records.

Transfer Records Out – Here is a form to print if you want us to send records to anohter doctor if you have moved away. Fill it out and send it to us.


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