Forms You Need to Fill Out Before Our First Meeting:
- Cover Sheet - Click Here to get this form
"This is the cover sheet for all your records." - Patient / Billing Information - Click Here to get this form
"This one-page form gives me basic patient information and billing information." - Patient Questionnaire - Click Here to get this form
"This gives me some information about how you're feeling and is often a good way to get started discussing your issues." - Insurance Authorization - Click Here to get this form
"This is what my office staff needs in order to file for payment through your insurance company." - Credit Card Authorization - Click Here to get this form
"If you would like my office staff to bill your co-pay or other charges to your credit card, please fill out this form and have it with you when we first meet." - Authorization to Release Information - Click Here to get this form
"This tells me and my office staff what information, if any, we can share with your primary care physican." - HIPAA Summary - Click Here to get this form
"This summarizes how we deal with your private information under the Health Insurance Portability and Accountability Act (HIPAA)." - HIPAA Verification Form - Click Here to get this form
"Please be sure to read the HIPAA Summary above - and then sign this HIPAA Verification Form before we first meet." - Billing Policies - Click Here to get this form
"This covers how my office staff bills you as well as related issues like cancellations, insurance coverage, late charges, and your responsibilities."
Important Additional Information You Should Read
- Fees - Click Here to get this form
"This is a summary of what I charge for my services."
