Complete your medical history form before your appointment
Please be sure to save the form to your computer before entering your information. Once completed, save the file and email it to firstname.lastname@example.org (or print and bring with you to your appointment).
- MEDICAL HISTORY FORM
- HIPAA NOTICE
- The HIPAA form available for download from our site describes how your health information may be used and disclosed by our office and how you can access this information. Please review the form carefully and print a copy for your records.
- HIPAA AUTHORIZATION
- In order to have your previous records and recent x-rays sent to our office, you can download and fill out the HIPAA Authorization form and submit the document to their office.
Adobe Reader is needed to view our patient forms. If you can not open the file, please download the Adobe Reader.