HIPAA is a federal law that requires new patients to read a Notice of Privacy Practices

you can find that at

 

After you have read the privacy practice you will need to print the pt form for privacy practices and sign it then return here to fille out the following

 

if you have insuance

new patient information sheet

patient medical release form (if you wish anyone else other than yourself to receive information from this clinic about you like your spouse, childern, etc)

assignment of benefits (so we can bill your insurance)

Financial responsibility

Patient initiated complaint form (so we can contact the insurance company and the board of insurance if your insurance fails to pay on your behalf) **Note you must fill out 2 of these forms

 

if you do not have ins

new pat info sheet

pat me releas form

Fianci resp.