New Adult Non-Physical Packet
New Adult Non-Physical Packet
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- Please complete prior to your first visit to provide us with basic non-health related information.
- Please also sign our Financial Policy in this packet and review the HIPAA Policy below.
New Adult Physical Packet
New Adult Physical Packet
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- Please complete this packet if you are scheduled for a New Patient Physical Exam.
- Please also sign our financial policy in this packet and review the HIPAA policy below.
New Pediatric Patient Packet
Updated Contact Information
Updated Contact Information
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- Please complete this form if your contact information has changed.
Annual Wellness Visit
Annual Wellness Visit
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- This packet is for any patient who has Medicare Insurance or a Medicare Advantage Plan.
- Please read the attached letter carefully and complete the Health Risk Assessment prior to your appointment.
Medical Records Release
Medical Records Release
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- Please complete if you would like us to receive information from a previous medical provider.
HIPAA Acknowledgement
HIPAA Acknowledgement
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- Please complete this Notice of Privacy Practices/HIPAA Acknowledgement form to acknowledge your understanding of HIPAA privacy practices.
Family & Friends HIPAA Release
Family & Friends HIPAA Release
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- Please complete if you would like to allow someone else to be able to discuss your care with your physician.
Annual Physical Questionnaire
Annual Physical Questionnaire
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- Please complete prior to your annual physical to provide a basic medical history as well as information about your current state of health to review with your physician.
Emotional Health Screening Form
Emotional Health Screening Form
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Your emotional health is as important as your physical health. If you have felt down, sad, or hopeless over the last 2 weeks or have felt little interest or pleasure in doing things, you may be depressed. Complete this form and then review with your doctor.
Kindergarten
Health Assessment Form
Kindergarten Health Assessment
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This form must be completed prior to kindergarten entry. Please plan ahead and schedule a physical for your child after age four and prior to kindergarten entry.