Accident | Personal Injury Intake Forms 

Below are the forms which you can print out and fill out at home and bring to our clinic to save time.

• ​Patient Intake Form :This form is for patients who are new to the clinic. Basic health information, areas of complaint, medication information, etc. will be submitted via these forms.
• HIPPA Notice of Privacy :This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.
• Cancelation policy We do our best to accommodate patients. We appreciate your cooperation with our cancellation policy as well as having respect for those who have scheduled appointments.
• Payment Agreement- Concerns your financial responsibility to the Health Care or Service Provider from whom you are about to receive services