Annual Update Forms
We are required to obtain updated paperwork from our patients
on an annual basis.
Please complete all the Annual Update forms, including the PCP Release form, even if you do not have a PCP.
If you don’t have a Primary Care Physician (PCP), please check the box “I do not have a PCP”.
If you change your insurance company or plan, please upload your new insurance card by clicking “Updated Insurance Card Submission” below so that we can verify your benefits. Any balance due on your account resulting from a change in insurance that we were not notified of prior to your appointment, will be your responsibility.
PLEASE SUBMIT THE FORMS ELECTRONICALLY
It is important to electronically “submit” the forms instead of printing them yourself. If you print them and bring them in,
it may result in having to to re-do the forms. These forms are a legal requirement in order to be seen as a patient at this practice.
How do I sign the online forms?
You can use a mouse to sign or your finger when signing on a mobile device, or track-pad enabled device (laptop, tablet).
If you don’t like your signature, just click ‘clear’ and try again.
Can I use initials, an ‘X’ or a line as a signature?
YES!! Your signature doesn’t need to be pretty or just something to indicate you ‘signed’ the document. See the examples provided
Forms to be Updated annually
- Consent for Treatment – (All new patients must complete)
- General Release (Please complete if you are being treated by any additional specialist and would like us to share information)
- Patient Information Sheet – (To be updated annually)
- Pharmacy Intake Form – (To be updated annually)
- Photo ID Submission
- PHQ-9 Form – (To be updated annually)
- Primary Care Physician (PCP) Release – (To be updated annually)
- Privacy Notice and Confidentiality Agreement – (To be updated annually)
- Updated Insurance Card Submission – (To be updated annually)