New Patient Forms
To establish our patient–care relationship with you, you must review and acknowledge that you have read our policies. Please fill out, sign and return Forms 1, 2, 3 and 4.
For Review, Print or Download:
- Form I – Patient – HPM Responsibility Acceptance
- Form 2 – HIPPA Privacy
- Form 3 – Use of Credit Cards
- Form 4 – Intake Questionnaire
- Form 5 - Patient Updated Information
- Form 6 – Financial Responsibility
- Form 7 – Patient Waiver
- Form 8 – Patient Handbook
- Form 9 – Medicare Private Contract
- Form 10 – HIPPA Guidelines