The list that follows is presented here in order to assist you to
relate efficiently with our office. In the event that you have
questions, concerns or difficulties, please contact our office for
DO NOT FORWARD ANY PRIVATE INFORMATION THROUGH THIS WEBSITE. YOU
MAY DOWNLOAD THE DOCUMENTS AND EITHER FORWARD THEM VIA FAX OR BRING
OR MAIL THEM TO THE OFFICE.
Patient Privacy is a very important issue. Please consult our policy in the pdf download.
||Patient Demographic and Insurance Form
This document with its information is necessary to help us be accurate in maintaining your medical records throughout our relationship with you.
||Patient History Form (PDF file, 46k)
This form will help us to understand your past medical history including
all the hospitalizations and operations that you may have had. It is
imperative that we understand your current medications as well as your
medication allergies. Your family history may have direct bearing on your
health in manners that may not be apparent to you at this time.
||Model Release (PDF file, 25k)
We hold all of your health care information in strict confidence. Many of
our operations involve very advanced technology and procedures. We are
involved in the development of some of these technologies as well as
teaching at the post-graduate level. We frequently photograph and "video"
parts of our operations for these educational purposes. The patient is
not identifiable in these photographs and/or videos. In the event that
you have questions concerning this, please feel free to discuss it with
||Welcome To Our Office (PDF file, 24k)
This form (to be signed by the patient in our office at the time of the
initial consultation) acknowledges that some fundamental information has been
provided to them.
||Patient Consent Form (PDF file, 42k)
||Patient Information Form (PDF file, 68k)
There are some forms that may be important for you to consider prior to your
admission to hospital.
This form instructs your physician and health care team regarding your
specific wishes about your health care and your life. Please read it
carefully. It is vitally important to you, your family and your health
||Power of Attorney
This form identifies the individual to whom you give the power to make
decisions regarding your health care in the unlikely event that you are
incapable of making those critical decisions.
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This page last edited on 2/19