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| New patients can save time by
filling this out, completing and bringing it at your first
appointment. Or this form is also useful in updating our records if
any of your information has changed (ie. address, phone number, insurance,
ect.). |
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| New Patients, or current patients that have never completed
this form should download, read, and bring in a signed copy
on the next visit. This sheet also happens to provide a lot of information
about the clinic such as hours, prescription refill policies, ect. |
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| This form authorizes us to copy your child's records for
various reasons (ie. transferring care, leaving the area,
or other personal reasons), This form is only needed if your child's
records will be sent from our clinic, and the form is only valid for
six months from the date of signature. Please allow us 30 days to
respond to your request for records transfer. |
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