Records Release

Forms used for any new patient visit are: Patient Update Form, Clinic Policy and Info, Pediatrics or Adult Patient Intake, and HIPAA Notice & Authorization.

Pre-Visit Assessment as it applies to you 

Medical Records if you need records transferred to or from our clinic

Medicare Risk Assessment if you are coming in for a Medicare Wellness.

HIPAA Authorization

HIPAA Notice

Patient Update Form

​​Adult Patient Intake

Pediatrics Patient Intake 

Schedule an Appointment

Pre-Visit Assessment

Click, print, fill out and bring with you!​

​​Medicare Patient Intake

Call Us:  (501) 843-4555