Please remember to bring a photo ID to your appointment. We ask for a copy of your photo ID to help protect you against medical identity theft.
New Patient Forms:
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Patient Registration FormRequired for new patients - Please print, complete and bring to your appointment.
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Assignment of Benefits and HIPAA NoticeRequired for new patients - Please print, complete and bring to your appointment
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Appointment Cancellation/ No-Show PolicyRequired for all patients - Please print, complete and bring to your appointment
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Diagnostic Procedure Financial NoticeRequired for new patients - Please print, complete and bring to your appointment
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Minor WaiverRequired when somone other than a legal guardian is bringing a minor to an appointment.
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Notice of Privacy PracticesPlease review
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Trouble opening forms?Click HERE to download a copy of Abobe Reader. A new window will open taking you to Adobe's site.You can also click on the link below to download a MS Word document containing some tips from Adobe on opening PDF files.
Out of Network Patient Forms:
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Out of Network Waiver - NEWRequired for Out of Network Patients
Established Patient Forms:
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Appointment Cancellation/ No-Show PolicyRequired for all patients - Please print, complete and bring to your appointment
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Minor WaiverRequired when somone other than a legal guardian is bringing a minor to an appointment.
Miscellaneous Forms:
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Protected Health Information Form
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VNG Instructions - 974 Bethel RoadPlease review this form if you are having a VNG performed at our 974 Bethel Road office.
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ENG Instructions - Clime RoadPlease review this form if you are having an ENG performed at our Clime Road office.
The Facial Cosmetic Center Forms:
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The Facial Cosmetic Center QuestionnaireOur online interactive facial center questionnaire
