New Patient

When you arrive at our office for your first visit, you will be asked to fill out a New Patient Package. You can print this document and fill it out before you arrive at the office, which can save both of us valuable time.

New Patient Packet

Information Sheet

This document records the your contact information, information concerning your spouse, parent or other responsible party, and your insurance data.

New Patient Information Sheet (Fill-In)

Office Policy Acknowledgment

This is a document that each patient signs acknowledging our Office Policies. We want to be sure, for example, that you are aware that our practice is purely a subspecialty rheumatology practice and that we do not treat general internal medicine problems. It is necessary for you, as it is for all of our patients, to have your own internist or who can follow your general medical conditions, and we ask each of our patients to acknowledge this and our other office policies.

Office Policy Acknowledgment

Agreement to Pay for Medical Services

Although our office will bill your insurance for you, you are principally responsible for the payment of all fees and costs incurred in connection with the medical services that we render for you. This document acts as a contract between us whereby you acknowledge this obligation.

Agreement to Pay for Services

Notice of Privacy Practices

Under the HIPAA law, you are entitled to receive a notice regarding certain privacy rights relating to your health care, and we are required to obtain your consent in connection with a variety of activities and disclosures.

Notice of Privacy Practices

Patient Authorization Form

This document allows us to discuss your medical care with other physicians, hospitals and insurance companies. It also allows you to specify certain information that you prefer we not disclose to such parties.

Authorization to Use Protected Health Information

Multidimensional Health Assessment Questionnaire

This document records initial basic health information about you that will assist us in the collection and analysis of information concerning your medical condition.


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