Privacy Acknowledgement Form
Please print and complete this form prior to your visit. This form inidcates you have reveiwed our Notice of Privacy Practice, listed upder "Patient Privacy". Please give the completed form to our registration receptionist upon arrival.
Designation of Personal Representative
You have the right to designate someone to have access to your health
care record. This access may include obtaining results, setting
up appointments or obtaining referral authorizations. If you are
interested in having someone designated, please print and complete this
form prior to your appointment.
Male Osteoporosis Screening Questionnaire
If you are having a bone mineral density test and would like to complete the required paperwork prior to your arrival, please print and complete the form now.
Female Osteoporosis Screening Questionnaire
If you are having a bone mineral density test and would like to complete the required paperwork prior to your arrival, please print and complete the form now.
Employee of the Month
Did one our our employees go above and beyond? Please let us know. Print this nomination form and mail to our administrator or drop it off at the office!