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.

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.

Initial Patient Information Form 

Medical Billing Information Form

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

Medical Billing Information Form
print and fill out by hand.

Medical History Form

Download 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


An assortment of traditional and alternative treatment approaches.
1  Link  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
2 Link    New Haven Chiropractic &Therapy
3 Link    Pace Chiropractic