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Forms

Please click on appropriate document required to print.

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General Forms

Credit Card Authorization


Lyme Treatment Form

Authorization for Unencrypted
Transmissions
 

Medical Release/Records Request Form

Allow 5-10 working days for processing. Records totaling over 10 pages will incur a .25 cent per page charge plus mailing. We cannot fax or email items over 10  pages.

Medicare Questionairre

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Notice of Privacy Form

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Informed Consent Form

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