Forms and Links

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.

Download
Medical Billing Information Form,
print and fill out by hand.

Medical History Form

Download PDF
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	Medline Plus
2	Patient Assistance Program
3	The Healthy Place

Forms and Links

Privacy Practices & HIPAA Form

Initial Patient Information Form

Medical Billing Information Form

Medical History Form

Medication Information

Alternative Treatments

ADHD

12 Step Programs

Recommended Chiropractors