Patient Forms

Patient Forms

For your convenience, please download and print the following forms prior to your visit

• Welcome to the Practice – (General Information Handout)
• Patient History Form
• Patient Informaton Form
• HIPAA Information Handout
• Patient Acknowledgement Form
• HIPAA Patients Rights and Responsibilities
• Notice of Privacy Practices
• Medical Records Release

• Blood Sugar Form
• Insurance Accepted – View a list of insurances we accept
• PORTAL POLICY:
  Our practices encourages patients to use the portal, but for routine matters only (test results, refills, routine blood glucose result review and appointment related matters). For matters such as high or low blood sugars or any physical complaints, please call the office to alert your physician about your concern.  The portal is not to be used for emergency or immediate medical concerns.  If you are unclear what is an an emergency or not, please call the office instead of using the portal as means of communication.