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*Transfer patients - please fill out the first three pages of the packet. Health history is not needed if you have seen the provider within two years.
If you need a form not listed here, please call us at 222-6887 and we will be happy to scan and email them to you directly.
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TELEMEDICINE VISITS ONLY!
We are now ONLY doing telemedicine visits . To be eligible, you need to contact your insurance company and ask if they will cover a 99213 or 99214 visit with a GT modifier code. Once you have done that, you can call us to set up a visit! Please see the message at the bottom of page one for more details.
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