Please download, print, fill out, sign, and date these forms with the date of your appointment with the doctor. You will need to have these forms with you at your scheduled appointment date and time, otherwise, your appointment may be cancelled or rescheduled. At your request, you may contact the office to have the forms emailed directly to you as an attachment.
If you are an ACUPUNCTURE PATIENT, download, print, & fill out these forms:
- Consent for Acupoint Injection Therapy
- Informed Consent to Treat
- Payment for Services Agreement
- Patient Office Policies
- Pain Assessment
- Patient Inform/Medical History
- Patient Inform/Medical History (Spanish)
- Notice of Privacy Practices NO SIGNATURES REQUIRED. READ ONLY.
- Privacy Practices Acknowledgement
- Patient Health Information Consent Form
If you are a PODIATRY PATIENT, download, print & fill out these forms:
- Patient Inform/Medical History (Podiatry)
- Notice of Privacy Practices NO SIGNATURES REQUIRED. READ ONLY.
- Privacy Practices Acknowledgement
- Patient Health Information Consent Form
- Podiatry Medicare Authorization
- Podiatry Consent General
- Podiatry Consent Surgery
If you are a GROUPON PATIENT, download, print, & fill out these forms:
