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Doctor's Desk

FORMS

Different visits have different requirements

If you have any questions on forms you may need for your

visit, please call our office directly

Please have forms printed and completed to bring with you to your visit

Select one of the sections titles below to be directed to your document

New Patient

Are you a new patient? We are delighted to welcome you to our practice! Our comprehensive new patient services include a thorough medical evaluation, personalized treatment plans, and ongoing support. We prioritize your comfort and strive to create a positive healthcare experience for you.

Release/Consent

We value our patients' privacy and understand that your health information is personal. Our Release and Consent Forms cover issues such as the release of medical records, email and text consent, and other key considerations. You can be confident that we treat your information with the utmost care and attention, and that your privacy is our top priority.

Annual Check-ups

Regular check-ups are essential for maintaining optimal health. Our annual check-up services include a comprehensive examination, preventive screenings, and personalized health recommendations. We believe in proactive healthcare and aim to detect any potential issues early on, ensuring timely intervention and improved outcomes.

New Patient

In order for us to get a better understanding of your past medical history and build your profile, we ask that you print and complete this form prior to your first appointment. Please bring the completed form with you to your visit.

New Patient - Polish

In order for us to get a better understanding of your past medical history and build your profile, we ask that you print and complete this form prior to your first appointment. Please bring the completed form with you to your visit.

Release of Medical Record

Authorization to release medical records from our office to another facility.

Email/Text Consent Form

For the ease of our patients, our office would like to offer the opportunity to communicate health information by email and text messages.

Email/Text Consent Form - Polish

For the ease of our patients, our office would like to offer the opportunity to communicate health information by email and text messages.

Annual Physical

A physical exam once a year allows your doctor to evaluate your overall health and provide routine preventative care.

Annual Physical - Polish

A physical exam once a year allows your doctor to evaluate your overall health and provide routine preventative care.

Annual Wellness Visit

For Medicare users, the AWV is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This visit is not a physical exam or a "checkup"

Annual Wellness Visit - Polish

For Medicare users, the AWV is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This visit is not a physical exam or a "checkup"

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