If you are a new patient in our practice, please print out and complete the New Patient Office Forms below at your convenience before your visit. If you bring the completed forms with you, you will not have to waste time in the office filling them out (or be told to go back to your car during the pandemic because we are not allowing waiting in the waiting room).
The New Patient Office Forms contain the Insurance Authorization Form, which tells us who you are and what health insurance you have; the New-Patient Self Assessment, which summarizes your medical history and symptoms; the HIPAA Signature Page, which indicates that you have been given an opportunity to review our office’s privacy practices (this is the next link after the New Patient Office Forms). You do not need to print out the Privacy Policy, it is for your information.
The HIPAA Signature Page indicates that you have been given an opportunity to review our office’s privacy practices (this is the last file). You do not need to print out the Privacy Policy, it is for your information.
In addition, if you are being evaluated for sinus problems, snoring, sleep apnea, or headaches, please click here to go to our Questionnaires page, where you can download and fill out some additional forms that will help us better to assess your symptoms.
The Medical Records Release form is your authorization for us to release some or all of your medical records to either you or someone you designate, such as another physician. Requests for release of medical records may take up to one week to be processed and sent to you or the recipient of your choice.
A few words about our office’s financial policy:
We understand that unexpected medical expenses can be stressful. To ensure a smooth billing process, we ask all patients to provide a credit card on file. This card will be used to charge any out-of-pocket expenses, such as deductibles, copays, or co-insurance, that are not covered by your insurance. By having a credit card on file, we can process any charges automatically, eliminating the hassle of dealing with bills and phone calls. If you like, we can notify you before we charge your card.
| Registration Forms and Other Miscellaneous Forms |
| New Patient Office Forms |
| Privacy Practices (You do not need to print this out!) |
| Medical Record Release Authorization |