NEW PATIENT PAPERWORK

If you are a new patient and would like to fill out the new patient forms prior to your appointment they are located below for you to download and print. Please bring all five forms filled out to your first appointment. 
*6.) Advanced Beneficiary Notice of Noncoverage form is for Medicare patients only.
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1.) Welcome New Patient Form.pdf
(173k)
Kent Hill,
Jan 14, 2018, 9:33 PM
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2.) Patient Health Survey Form.pdf
(338k)
Kent Hill,
Jan 15, 2018, 7:15 PM
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3.) Consent Form.pdf
(254k)
Kent Hill,
Jan 14, 2018, 9:34 PM
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4.) Payment Sheet Form.pdf
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Kent Hill,
Jan 18, 2018, 11:54 AM
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5.) Disclosure of Fees Form.pdf
(418k)
Kent Hill,
Jan 14, 2018, 9:37 PM
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6.) Advance Beneficiary Notice of Noncoverage.pdf
(143k)
Kent Hill,
Sep 2, 2020, 12:17 PM
v.1