New Patient Registration
We know that your time is valuable, to help speed up the registration process, we ask that you print out, complete and bring the following forms with you to your first appointment. By filling out these forms before your first visit, we can keep the time you spend at the reception as short as possible. In addition, please bring any your insurance card, co-payment, and all medications you are taking currently. Also, if you have a copy of your current medical record, please bring it, we can also help you fill out a form requesting the transfer of your medical record.
There are the 3 required documents in the new patient registration package.
1) New Patient Registration Journey To Wellness – Please fill this out as completely, including your contact, email, and your emergency contact. This packet includes financial policy, HIPPA acknowledgement, prescription history, and all new patient registration questions.
2) Notice of Privacy Practices – Effective as of April 14, 2003, there are a set of federal regulations (HIPAA) concerning the appropriate use of information related to health care. Part of these regulations stipulates that you must be informed of the impact of this legislation, so you will be asked to sign a form to acknowledge receipt of this document. Feel free to contact us with any questions, since we are not allowed to provide care unless these guidelines are complied with. This form is for your information only – you do not need to return it to us.
3) Authorization For Release of Medical Records Availability of your past medical records ensures continuity of care.
We hope that getting this paperwork done ahead of time makes your visit easier. Please feel free to contact us if you have any further questions.
Hormone Restoration Forms
Click here for Hormone Restoration Female
Click here for Hormone Restoration Male
Please print and bring the signed consent form to your scheduled pellet appointment.