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The following forms can be printed, signed and mailed or faxed (our
address information and fax number are on each form).
PRIVACY POLICIES FORM
PRIVACY PROCEDURES FORM
PATIENT CONSENT FORM
AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH
INFORMATION
CONSENT FORM FOR HIV ANTIBODY TEST
AFP SCREENING
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The following forms can be filled in
online. After completion, click on the submit button (located at bottom of page) to send
the form as an encrypted e-mail, or print the form and bring to the office.
PATIENT REGISTRATION FORM
GENERAL HISTORY FORM
APPOINTMENT FORM
PAY ONLINE
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