Forms

These are some of the forms you may need for your visit or to have records transferred. Clicking the link will open the form in Adobe PDF format. You will need PDF reader to open and print the forms.They must be printed to fill them out, as they are not designed to be filled out online. If you do not have PDF reader you can download it for free here: Adobe Reader

When you click on a link on this page you may need to press the "back" arrow on your browser to return to this page. You can also hold down the CTRL key while clicking to open the link in a new tab, or the SHIFT key while clicking to open it in a new window.

 

Demographics form

 

History Questionnaire

 

Symptom Questionnaire

 

Auto Claim form

 

Release of Information (to BAFC)

 

Release of Information (from BAFC)

 

HIPAA Privacy Practices