Forms

  • Not yet a patient? Start here.

    UpdoxIf you are interested in becoming a patient of our office, we would love to see you!  After visiting our insurance participation page to see if we accept your insurance, please visit our secure New Patient Questionnaire form at our Updox portal and complete the form to get the process started.  Once this is completed and you are scheduled, we will need the following "New Patient" forms completed.

  • New Patient Forms

    All new patients who have already scheduled an appointment, please print and complete the following forms and bring them to your first appointment. Otherwise, you can arrive 15 minutes before your first appointment so we may give you the forms to complete in our office:

  • Obtaining Medical Records

    • Incoming Patients: Please mail this form to your previous physician to have your medical records forwarded to our office.

    • Outgoing Patients: If you are relocating and need your medical records transfered from our office to another physician, please complete this form and mail to our office.  We will forward your records to your new practitioner.

  • Privacy/Information Release

    • We are unable to release any information regarding healthcare, appointments, billing or insurance information to your spouse, parent, family members, significant others or friends without written authorization from the patient. 
    • If you would like us to speak to anyone other than yourself regarding any of these issues, please print the medical release to family member form and return it to our office. 
    • Patients over the age of 14 years must sign for themselves.
  • Wellness Health History

    When our Medicare patients schedule your wellness exam, please fill out the Wellness Health History form and bring it with you to your wellness check.  Otherwise, please arrive in time to fill it out in our office before your appointment.

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    Living Will / Advance Directive

    An advance directive is a written instruction that you make while you are mentally competent that states how you want your health care decisions to be made if you become incapacitated or cannot express your wishes. Advance directives guide your physician and other health care professionals, and relieve your family from the burden of guessing what types of care and treatment you would want to receive.  

    The Alabama Hospital Association makes a standard Living Will/Advance Directive form available online.  You can download it here.

    After you complete the form?

    Make a copy of the completed and signed form and give it to the person you have appointed to make decisions on your behalf (family, friends, or health care provider) so the form is available in the event of an emergency.


    And what about After-After?

    In the theme of advance planning, we like to remind everyone that preparing for your family's well being in the event of your death doesn't just mean buying funeral plots and life insurance. One inexpensive alternative to planning a traditional funeral or cremation-- one that offers numerous benefits to the education of future generations (of those entering the medical profession and those who rely on medical professionals) is body donation.  To learn more about becoming an anatomical donor, visit the UAB School of Medicine website.

  • Patient Survey

    We're sure you have an opinion about your experience with us, and that opinion helps us to know how we are doing as your healthcare provider.  Please tell us what you think by downloading our Patient Survey and then mail or fax it back to our office.

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