Available Forms
*1 New Patients: Consent for Treatment & Payment & Acknowledgements
*2 New Patients: Cancellation & No Show Agreement
*3 New Patients: Text Messaging
*4 New Patients: Patient Financial Responsibility
*5 New Patients: Updox Patient Portal
*6 New Patients: Telehealth (VideoChat)Consent form
*7 New Patients: Alternate Phone/Person
*8 New Patients: Address and Insurance form
*9 New Patients: Medical Records Request To Us
10) New Patients: Please Read! Thank you!
11) Beauty 01 Consent
12) Beauty 02 Cancellation & No Show Agreement
13) Beauty 03 Intake Form
14) Beauty 04 Patient Financial Responsibility
15) Beauty 05 Photo Authorization
16) Beauty 06 Text Messaging
17) Beauty 07 Alternate Phone/Person
18) Beauty 08 Updox Patient Portal
19) Beauty 09 Telehealth (VideoChat) Consent form
20) Beauty 10 Address and New card form
21) Beauty 11 Medical Records Request To Us
22) Beauty 12 Inquiry for Payment Plan
24) Patients Rights & Responsibilities
27) Telehealth (VideoChat) Consent form
31) Address and Insurance Update form
34) Consent for Payment Plan
35) Medical Records Request From
Care Management Request for Medicare
CCM Staff Log
Patient Satisfaction Survey
Prescription Refill Request