Patient Forms

Patient Form
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Purpose / Description
New Patient Forms
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General information needed for each new patient... i.e - Name, Address, City, State, etc...
Medical Records Release
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Allows you to give us the legal right to release sensitive Health Information to other health providers...
HIPAA Authorization
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This form grants us permission to discuss your medical care and/or leave phone messages regarding your care only (and ONLY) with the people you list. This includes your health information, laboratory results, test results & financial information.

HIPAA - Health Information Portability & Accountability Act

Female Health Assessment Questionnaire
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This female BioIdentical Hormone Questionnaire gives us both a good indication as to whether or not our RightBalance Hormone replacement therapy might be of help...
Male Health Assessment Questionnaire
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This male BioIdentical Hormone Questionnaire gives us both a good indication as to whether or not our RightBalance Hormone replacement therapy might be of help...
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