1st Visit Forms:

1. Policy on Confidentiality
(For your records)

2. Notice of Privacy Practices
Patient Acknowledgment
( To be filled out and signed)

3. Patient Consent
For Use and Disclosure of
Protected Health Information (To be signed)

4. New Patient Intake Form
(To be filled out and signed)

5. Patient Questionnaire
(Medical form to be filled out - both sides for doctor)

Please print and fill out these forms. Bring the completed forms with you to your initial evaluation.