Patient Forms

In order to expedite the process of your office visit, feel free to download, print and complete this forms and bring them with you during you office visit.

• Hippa Privacy Policy (26KB)
• Patient Registration (61KB)
• Change of Information (30KB)
• Authorization to Release Medical Records (68KB)
• Authorization to Release Medical Records to another Physician (70KB)

Fees for Form Completion

There is a service charge for completing forms without an appointment. Payment must be received before forms are completed. Alternatively there is NO charge for simple forms (one page) completed at the time of your appointment. Other fees are set as follows:

• Immunization records - $5 per copy
• Medical Records (Allow one week to complete) Patient pick-up - $25.
  For Insurance or business request - $35 to $45
• Forms or Letter for Physician Signature - $25 to $35 (Allow one week to complete)
• FMLA or Disability - $25 to $40
  (Allow one week to complete)
• Forms & Letters (Allow one week to complete)$5 to $10
  (Lou Walker, Handicap Sticker, Return to School/Work Note)
• Sports Physical Forms $10 to $35
• Notary Service: Non-Clinical or Non-Patient Related cost $5

Same Day forms without appointments cannot be completed due to time constraints.We appreciate your attention to these service charges.