PLEASE MAKE SURE TO READ OVER THE FORM AND FILL IN AS MUCH INFORMATION YOU CAN ABOUT INSURANCE, CONTACT INFORMATION, HEALTH HISTORY. WHEN YOU COME IN THE OFFICE YOU WILL SIGN THAT YOU UNDERSTAND AND HAVE BEEN AWARE OF THE HIPAA POLICY AND UNDERSTAND THAT INSURANCE YOU ARE FINANCIALLY RESPONSIBLE FOR ALL CHARGES WHETHER OR NOT PAID BY INSURANCE.

BE SURE TO GIVE US AS MUCH MEDICAL HISTORY AS POSSIBLE.