This form is to request your past medical records from other healthcare facilities.
This form authorizes us to use and disclose any treatment, payment, or healthcare operations. You may also add others who will be authorized to access your protected healthcare information.
New patients are asked to arrive 30 minutes prior to their appointment to allow time to fill out any forms. Established patients should arrive 15 minutes prior to their appointment to allow time for updating their medical record.
Your time is valuable to us and we make every effort to keep appointments on schedule. However, we may need to reschedule your appointment if you are 15 minutes past your original scheduled time so other patients will not miss their scheduled appointments.
On the day of your appointment, please bring your identification and insurance cards. Also, be prepared to pay and co-pay or deductible applicable to your insurance plan. Our staff can assist you before your arrival in determining what your payment responsibility may be.
Two days before your appointment, you will be emailed paperwork to the email you provided to our staff. This electronic paperwork allows you to update and change medical and demographic information before your appointment. Please note that this is not the same thing as the patient portal – you will not fill out any paperwork on the patient portal.