Patient Forms
New Patient Forms
- New Patient Welcome Letter
- Patient Registration/ Demographic Information
- Patient Privacy Information Authorization
- Notice of Privacy Practices
- Patient Financial Responsibility Form
- Consent for Release and Use of Confidential Information and Receipt of Notice of Privacy Practices Form
- New Patient History Form
Returning Patient Forms
- Annual Exam
- Patient Registration/ Demographic Information
- Patient Privacy Information Authorization
- Notice of Privacy Practices
- Patient Financial Responsibility Form
- Consent for Release and Use of Confidential Information and Receipt of Notice of Privacy Practices Form
Medical Release Form
Billing Information
We accept almost all health insurance policies, however if you have any questions concerning coverage please call our billing service. Our biller, Faye Fields, will be happy to assist you. At this time we do not accept Medicare, Medicaid or Public Aid.
Specialized Billing Services
Faye Fields
1-877-511-2688
Email Questions to Faye@aembilling.com
Customer Comments
