Patient Forms

 

Dr. Diaz Patient Forms

We ask that our patients complete the appropriate forms prior to their appointment. By doing this, we will be able to provide our patients with a better service.

All patients should bring their insurance cards and information about the primary insured person on the health insurance policy. Co-pays and deductibles are due at the time of service.

We accept all major credit cards. Self-pay patients are also welcome.

Payments are expected when services are provided.

 

Forms can be downloaded here:

 

HIPAA
– All patients every year
Intake
– All patients every year
Medical History
– All new patients
Release of Medical Records
– Established Patients (Charges apply)
Release of Medical Records
– New Patients

 

The practice may charge for copies of records or other forms.

Please Contact Us if you have any questions.