|
|
|
|
|
by printing and filling out the following four forms.
All forms are in PDF format;
you will need Acrobat Reader (a free
software) to view and print them.
» Download Adobe Acrobat
|
Patient Information Form
This (3) page form details your personal information
and medical history.
» Download
Patient Record of Disclosure
This (1) page form tells us how best to contact you
and protect your privacy.
» Download
Notice of Privacy Practices
This (2) page form details how we handle your medical records and your rights concerning these records.
» Download
Acknowledgment of Privacy Practices
This very simple form ensures that you have received and read Dr. Greens Notice of Privacy Practices (the above form.)
» Download
Download all (4) forms at once
.zip file
(Needs WinZip software to open)
» Download Forms
» Download WinZip
If you have any questions, feel free to
call us at 505-988-2215.
|
|
|
|
