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Established Annual Update Forms


 

PATIENT ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES / RELEASE OF MEDICAL INFORMATION

NOTICE TO ALL PATIENTS

FINANCIAL POLICY

BRCA SCREENING

Please arrive 15 minutes prior to your scheduled time so that we can ensure your paperwork is complete.

You will need to bring the following:

  • Completed Established Annual Update Forms (click the “PATIENT FORMS” tab and select “Established Annual Update Forms” from the drop-down or you can click the link for the forms right here
  • Your new issued insurance card (if you do not have the card, please print a copy)
  • An updated list of medications you are currently taking

Before you come:

Take a moment to write down questions and topics you want to discuss. For example:

  • Health Concerns
  • Symptoms, when they started, how long they last, any medications you may be taking for them.
  • Changes to your daily routine or your lifestyle. Change in diet – what foods are you eating or not eating? If you started a new exercise routine, how often and how long are you working out?
  • Recent major life events. If you have switched jobs, experienced loss, divorced or gone through another significant change.