Downloadable Forms

Please download, print, and complete the forms below. You will need to bring all of these completed forms with you to your first appointment.

When you arrive for your appointment, we will make a copy of your insurance card, Medicare card, and driver's license or photo ID to keep with your chart. If you are having a breast exam, you must bring your films and report of your last mammogram and/or ultrasound to avoid having to reschedule appointment.

Under Federal Law, physicians are required to collect all copayments and any allowed amount not covered by a patient's insurance policy. It is our policy to collect predetermined copays, coinsurance, and/or deductibles prior to services being rendered. To do so otherwise opens the physician's office to possible charges of fraud. We accept Visa, MasterCard, and Debit cards. We appreciate your understanding and compliance with this necessary policy.