New Patient Paperwork (This is NOT the membership application: See homepage)

• Patient Information Sheet

• Patient Agreement

• Terms of Service (Appendix 1)

• Patient Financial and Medication Policy

• Membership Agreement (Appendix 2)

• Request for Medical Records/Release of Information

• Medicare Opt Out Agreement (Appendix 3: for patients who carry Medicare Coverage ONLY)

• Patient Health History

• Account Authorization Form (must be completed if patient is not primary/joint account holder)

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