top of page

New Patient Paperwork

Medical Records
Release Form

Notice and Acknowledgement of Privacy Practices

Our New Patient Paperwork is attached above. New patients are advised to print and fill out this paperwork prior to their appointment.

Our medical record release form is attached above. This form is for patients who wish to transfer medical records to any other health care facility or provider.

Protecting the privacy of your medical information is required by law and we respect and carefully abide by that law. You should carefully read these forms - and then acknowledge your acceptance of their condition by signing should you choose to do so. These forms must be completed and returned to the clinic at the time of the patient's first visit. You should list names of person(s) that are permitted to access to your (or the patient's) protected health information. No information will be shared with anyone who is not listed on this form.

Anchor 1
Medical form with stethoscope
bottom of page