Policies

Patient Forms

Financial Policy (PDF) English and – En espanol– This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Authorization for Release of Medical Information (PDF) – En espanol– Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Authorization and Consent for Treatment (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento

Preferred Contacts (PDF)– Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos