Medical Information forms
Our practice requires that you fill out certain forms. You may download these forms here and have them filled out before your visit, or you may fill them out at the time of your visit. If you intend to fill them out at our office, please allow 20 minutes to fill out your forms before your actual appointment.
Please bring the following items with you at the time of your appointment
- Completed Patient Medical Questionnaire, HIPPA & the Patient Information Forms. Please include a printed list of all medications/dosages and all vitamins and herbal supplements that you are currently taking.
- Health Insurance Card(s).
- Co-Payment, if required (we accept cash, personal checks, VISA, Mastercard & debit cards
- Insurance referral from your Primary Care Physician (if required). It is the patient's responsibility to request and confirm insurance referral from their primary care physician.
- If you need to reschedule the above date, please give us a 24 hour notice. Failure to keep the appointment without prior notice is subject to a $30.00 cancellation fee.
If you have any questions, please do not hesitate to call our office at (860) 826-3880.
For an online notice of our privacy practices, please click on this link.