Forms

Forms


Patient forms

For your convenience, we have attached the new patient forms. Please complete and take with you to your first appointment. Other necessary items for your first appointment include a valid id, a copy of your insurance card, and any copay due (if applicable). 

HIPPA

HIPAA notice


New Patient Forms

HIPAA Authorization

New patient health questionnaire

New patient Registration form

Credit Policy


Yearly Forms

Yearly History Form


Medical Records

Medical Records Release Form

Contact Dr Lippert's office to schedule an appointment.

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