Patient Forms
Complete and sign your forms securely online. Once signed, a copy is sent to our team and to your email automatically.
Complete All Forms at Once
Takes about 5 minutes: enter your information once in short steps, accept each document, and sign a single time at the end. Everything is combined into one signed PDF packet.
Or fill out forms individually:
HIPAA NOTICE OF PRIVACY PRACTICES
Notice on how we protect and use your medical information, and acknowledgment of receipt.
PATIENT’S BILL OF RIGHTS AND DUTIES
Summary of the rights and responsibilities governing the care relationship, with record of receipt.
NOTICE AND POLICY OF NON-DISCRIMINATION
The practice’s civil rights and non-discrimination policy, with acknowledgment of receipt.
CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT
Agreement to protect the privacy of other patients, staff, and non-public practice information.
LIMITED RELEASE OF LIABILITY
Acknowledgment of risks and responsibilities when receiving health services from the practice.
INFORMED CONSENT AND ACKNOWLEDGMENT OF RISKS FOR THE USE OF PEPTIDES, COMPOUNDED MEDICATIONS, AND OTHER PRODUCTS NOT APPROVED BY THE FDA
Informed consent for treatments with peptides, compounded medications, or products not approved by the FDA.
DESIGNATION OF CONTACT PERSON
Designate a contact person and authorize what information may be shared with them.
PAYMENT COMMITMENT AND PLAN
Payment plan agreement for balances payable by the patient or responsible payer.