New Patients: please print the forms below and bring them with you, filled out, to your first appointment:
HIPAA Privacy Rules ask that we provide you with a Notice of Privacy Practices. Please print out, sign & bring in this Privacy Practices Acknowledgement and Consent to confirm we did.
Medical Records:
If you are bringing copies of your Medical Records as discussed when you scheduled your appointment, please be sure to bring copies that we can keep in your chart.
If you need to request that copies of your medical records be sent directly to our office from another health care provider, you can use this Medical Records Release Form.
[Note: The forms above are PDF files. If you don't have a PDF Reader, click here to get to the Adobe Acrobat site, where you can download a free Adobe Acrobat Reader.]
Electronic Forms:
If you don't have the ability to print, please find electronic versions of some of the new patient forms below. If you have Word; you'll be able to download the files, type your answers directly into the documents, save them and email them back to us. (If you are printing these out to fill in by hand, be sure to use the ones at the top of the page rather than the ones below.)
Please call the office at 860-763-1225 for the email address you should use. In the email, please include the name of the new patient as well as your scheduled appointment date/time. You can sign the HIPAA form when you arrive for your appointment.