IMPORTANT! Though services provided by our practice are covered by most insurance companies, it is your
responsibility to verify with your insurance plan that your specific group and policy number are covered or are in-network with our providers. *We are unable to verify insurance as a service to our patients at this time.*
Click on all four links below to download forms, then email or fax them to us or print them and bring completed to your appointment. The email for sending forms is firstname.lastname@example.org. (Please do not use this email for other types of communication unless directed.)
Health Records Release Authorization
One of the easiest ways to have medical records from another office or institution transferred to our office is to contact the medical facility directly and request records to be securely faxed or mailed to us. If you prefer to have us e-fax your request, you may select the link below and complete and submit the form to our office. The second page only needs to be completed if you are requesting our office to transfer records to another facility. We respect your privacy by adhering to standard medical office privacy guidelines.