Forms

For your convenience we have included copies of all the forms we use in our office below. Please feel free to print any of them by clicking on the appropriate link. Completed forms may be returned to our office by mail, fax or by dropping them off at the front desk.

Fax: 803.364-2014 | Mailing Address: PO Box 630 Prosperity SC 292127

 

NEW PATIENT PAPERWORK – COMPLETE PACKET

INDIVIDUAL FORMS

Acknowledgement of Receipt of Privacy Practices
Audio or Video Recording
HIPAA Form
New Patient Past Medical History Form – English
New Patient Past Medical History Form – Spanish
Notice of Privacy Practices
Patient Information
Records Release Form
Records Request Form