Forms

Required Registration Forms

• Patient Registration Form
• HIPAA (Notice of Privacy Practices)
• Authorization to Release Medical Records/Information

Only one form is necessary for each family.

General Forms

• Authorization of Delegate - Minor

  For legally authorized patient representatives (parent/guardian) of a patient under 18 to delegate another person to act on the representative's behalf (i.e. grandparent, aunt).

School Forms

• We will print out school forms in the office