Registration, Acknowledgements, and PHI Consent
Insurance Verification, Financial Responsibility, Emergency Contacts, Acknowledgements, and Patient Consent for Uses and Disclosures of Protected Health Information (PHI).
Health, Family, and Work History
The confidential information provided with this form helps us more effectively and thoroughly understand you and the specific circumstances which bring you to visit us.
Personality, Attitude, and Behavior Survey
A quick response checklist we use to gauge the psychological well-being and current circumstances of new patients related to attitudes, values, and opinions.
Medical Records Release
Uses and Disclosures of Protected Health Information (PHI)
This patient authorization is required by the HIPAA Privacy Rule for uses and disclosures of Protected Health Information (PHI) not otherwise allowed.