 |
Patient Forms
These forms may be downloaded and printed; you may bring completed forms with you to your visit, or mail them (in advance) to the office address where your clinical records are kept.
Please do NOT email them since they contain confidential (protected) medical information.
New Patient History Form Patient Information ING Patient Privacy Policy (HIPAA) ING Financial/Payment Policy ING Disclosure of Financial Interests Release Medical Information
(Patient Authorization)Request Medical Information
(Patient Authorization)The following forms are intended for patients being seen in our Lafayette office only. If you are a Lafayette patient, you do not need to complete any of the forms above; you only need to complete the forms below and bring them with you to your appointment in Lafayette. New Patient History Form
(Lafayette Office Only)
To download a free copy of Acrobat Reader from Adobe - Click Here
