Forms (To be Completed & Brought to First
Visit)
Authorization
To Release Information
Acknowledgement
of Privacy Practices (Please read the Health Insurance
Portability & Accountability
Notice first before signing this form)
Financial
Responsibility Agreement
Consent
for Non-Guardian to Authorize Treatment (Only necessary
if a non-guardian is bringing the child)
Policies
Notice
of Privacy Practices
Heath
Insurance Portability & Accountability (HIPPA) Notice
|