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Our Forms
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New Patient Form
At the link below, you will be able to fill out the new patient forms. Note: it has several tabs. Each tab must be completed before advancing to the next tab.
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Notice of Privacy Practices and Acknowledgement
Click Here
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Patient Insurance Waiver
Click Here
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Notice to HMO Members
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Use of Email Consent
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Financial Policy
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Telemedicine Consent
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Payment Authorization
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Use of Medical Scribe Services
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Missed Appointment Policy
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Current Patient Additional Forms
Are these forms really necessary?
Yes!
Each form is designed to protect the interests of both parties, the client as well as the caregiver
Learn more about who Nurse Practitioners are.
Insurances Accepted: Medicare, Blue Cross Blue Shield (all HMO & PPO), CIGNA (all HMO & PPO), United Healthcare (all HMO & PPO); we offer discounts to self-paying clients.
Office Hours:
| Monday: | 7am-5pm |
| Tuesday: | 9am-5pm |
| Wednesday: | 9am-5pm |
| Thursday: | 9am-5pm |
| Friday: | 7am-5pm |
*Closed for lunch daily
12:45pm-1:45pm