Patient Forms & Information
NP Intake Form
Notice of Privacy Practices / HIPAA
Please use a PDF Reader and printer to print out the forms, fill out completely and bring with you for your appointment.
Consultation Policy
There is a $50 fee requirement to book an appointment with the physician. If you proceed to schedule a surgery, the $50 booking fee will be applied toward your surgery.
Appointment & Cancellation Policy
Our goal is to provide quality health care for our patients. Please assure to arrive on time to your appointment. No-shows, late arrivals, and cancellations inconvenience our providers and other patients. Please be aware of our policy regarding missed appointments and late cancellations.
Late Cancellations/No-Shows
- A cancellation is considered a late appointment when canceled less than 48 hours before the scheduled appointment.
- A no-show is when a patient misses an appointment without canceling.
- We will charge the patient an additional $75 missed appointment fee in either case.
In the event of a no show or late cancellation, the $50 consultation fee, this will not be refunded or applied toward scheduling a new appointment. In this case to schedule a new appointment an additional $ 50 deposit needs to be paid.