|Prior Treatment History|
Prior Treatment History Form
Just a summary of our office policies.
|Patient Registration Forms|
The packet includes: Registration Information, Consent for Treatment, Office Policies & Procedures, Patient Report, and the Symptom Checklist.
|Outgoing Patient Records Form|
Consent to release our patient’s information to outside organizations.
|Incoming Patient Records Form|
Consent to release patient information from outside organizations to our office.
|Credit Card Authorization Form|
This form will be under lock and key along with your medical records.
|Freespira Program Registration Paperwork|
Explanation of the program and policies
|Assignment of Benefits Agreement|
Our policies governing insurance claims.