Privacy Practices & HIPAA Form

This 6-page PDF document (including one-page form) is a required "notice of privacy practices" (NPP) in keeping with Federal HIPAA (Health Insurance Portability and Accountability Act, 1996) requirements. Click to download, print and fill out by hand.

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Privacy Practices & HIPAA Form 

Initial Patient Information Form

Two-page form in PDF format: Name, address, phone, Emergency Contact Information, Receipt of Notice of Privacy Practices. Click to download, print and fill out by hand.

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Initial Patient Information Form 

Medical Billing Information Form

One-page form in MS Word format: Primary Care Provider, emergency contact info, insurance information.

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Medical Billing Information Form
print and fill out by hand.

Medical History Form

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Medical History Form,
print and fill out by hand.

Medication Information

Information on specific medications, side effects, and contraindications.  Also a link to a patient assistance program offering aid for people that need financial help paying for their medications.
1   Link  Medline Plus
2   Link  Patient Assistance Program
3   Link  The Healthy Place

ADHD

An assortment of traditional and alternative treatment approaches.
1   ADHD Treatment Summary

12 Step Programs

Links to the most popular 12 step organizations with meeting schedules.
1   Link   Alanon/Alateen
2   Link   Alcoholics Anonymous
3   Link   Codependents Anonymous
4   Link   Gamblers Anonymous
5   Link   Narcotics Anonymous
6   Link   Overeaters Anonymous

Recommended Chiropractors

Here is a list of local chiropractors that are recommended by this office.
1   Link  Coastal Chiropractic