Forms

Below are some of the forms we frequently need to assist our patients. To view the file just click on it. We have designed these forms so that you can fill them out on your computer and then print them to bring with you to the office.

How to use these forms:

This depends largely on your browser. In some browsers (Internet Explorer, FireFox, Chrome) depending on your settings, these should open in a wnidow that will allow you to fill in the forms and then print them to bring to the office.

If you do not see boxes allowing you to fill in the forms you must download them to your computer and then open them in Adobe Reader. This will allow you to complete the form on your computer, typing your responses. Once complete please print the document and bring it with you to the office.

If you prefer to handwrite your responses simply print them and write in your answers.

To download the forms RIGHT CLICK on the blue file name and select "Save As". This will save the document to your computer allowing you to open them with Adobe Reader and fill out the forms.

If you do not have Adobe Reader you can click here to get the free download.

• Patient Registration Form- a form that provides us with basic information about you and your insurance coverage.

• Medical History Questionnaire- Provides AMA with a detailed medical history

• Click here to read our HIPPA Notice of Privacy: We need to present you with this information so you understand how we protect your privacy and how we may use your information. You must provide a signed Patient Disclosure Form (below) to confirm that this information was presented to you.

• Patient Disclosure Form- This form not only acts as a reeipt for our presenting to you our HIPPA Notice of Privacy (Above), it also tells how how you would like to be contacted, who, if anyone, we may speak with about your medical information.

• Authorization to Release Medical Records to Allied Medical Associates- For patients that are moving to our practice for their medical care. This allows us to receive a copy of your medical records from your previous Doctor.

• Authorization to release Medical Records to other practices.- Gives us permission to release your medical records to another practice.

• Workers Compensation Form- For patients hurt on the job seeking to be covered under their employers Workers Compensation Insurance Policy.

• Advance Beneficiary Notice of Non-Coverage (ABN)- AThis provides assurance that you will be responsible for all fees.