|
|
|
|
1. Client Demographic Information (Print and Complete) READ IMPORTANT NOTICE BELOW
2. Office Policies/Financial Agreement (Print, Read Carefully, and Sign) READ IMPORTANT NOTICE BELOW
3. Notice of Privacy Practices (Print, Read Carefully, and Sign) READ IMPORTANT NOTICE BELOW
4. Adult AMEN (Age 16 and older) (Print and complete) READ IMPORTANT NOTICE BELOW
5. Adult Intake Questionnaire (Age 16 and older) (Print and Complete) READ IMPORTANT NOTICE BELOW
6. Parent Questionnaire (For patients under 16, parents please print and complete this form instead of #5 and #6 above)
READ IMPORTANT NOTICE BELOW 7.
Dr.
Blair's Health Questionnaire (For patients who will only see Dr.
Blair) 8.
Dr. Blair's Notice of Privacy Practices (For patients who will only see Dr.
Blair) 9. Dr. Blair's Office Procedures (For patients who will only see Dr. Blair)
All required forms must be completed BEFORE your appointment. Your appointment may be rescheduled and a rebooking fee (currently $50) charged if you do not complete these forms prior to the appointment. If you have any difficulties with these forms, please call 946-9715 to request assistance.
|
|
|
