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forms

Forms for you to print, fill out, and bring to your first appointment:

New patient: Registration form

New patient: Adult medical history (Age 16 and older)

New patient: Child medical history (Under age 16)

New Patient Policy Agreement

Release of Records – fill out and send to your previous care provider/s, including the Emergency Room and Urgent Care, to get your old records faxed to Dr. Leigh

Private contract, for people who have Medicare only (required by the Gov’t)

Advance Directives: please read!

Policies and advice:

Dr Leigh’s Policies and Procedures

HIPAA: Your healthcare privacy

Medical identity theft

How to deal with insurance

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