Please complete and bring these 3 forms with you to your appointment OR you may scan your completed forms and email them to: firstname.lastname@example.org
We ask that you arrive at least 10 minutes before your appointment to allow for registration. If you are more than 10 minutes late for your appointment, we will ask you to reschedule to the next available appointment time/date.
We require 3 business days to prepare your medical records. Our fee for this service is based on the total number of pages contained in the requested record.
In the event a patient requires us to complete paperwork from an outside source, depending on the complexity & time involved, a service charge may be assessed. Short forms, requiring minimal time to complete, will be assessed a $10 fee. Complex forms requiring 15 or more minutes to complete, which do not require an office visit, will be assessed a $35 fee. Some form completion work requires an office visit with your physician. In this case, the standard office visit charge will apply.