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Demographic Sheet

Print – Complete – Fax/Bring with you to office visit.
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Consent form to request Medical Records

Print – Complete application and mail to your insurance company.
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Questionnaires

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Medication sheet

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HIPAA Policy

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Insurance List

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Primary Care Walk In Clinic as participating provider

Print – Complete application and mail to your insurance company.
Click here for file

Consent form for Flu Shot

Click here for file