Your First Visit

In order to comply with Federal Health Insurance Portability and Accountability Act (HIPAA) regulations, effective April 14, 2003, every family will be required to complete the new registration forms for our records. Please complete the Patient Information Sheet, Financial Agreement/ Authorization for Treatment/ Summary of Notice of Privacy Practices and the HIPAA Privacy Authorization Form. The Notice of Privacy Practices will outline your rights regarding the release of Protected Health Information (PHI). We ask that you complete the information thoroughly and accurately, as incomplete forms may delay your appointment.

Required Forms:

1. Patient Information Sheet
2. Financial Agreement/ Authorization for Treatment/ Summary of Notice of Privacy Practices
3. HIPAA Privacy Authorization Form
4. Notice of Privacy Practices (3 pages)