On your initial visit, there are three forms that we ask you to fill out to assist us in providing you with the best care.  For your convenience, we provide these forms on our website so that you may fill them out ahead of time and spend less time doing so on the day of your appointment.

 

The forms below are in PDF format.  You may need the free Adobe Reader (click here) to open them.  Please download all three documents prior to your visit:

 

FOR NEW PATIENTS:

 

1)  New Patient Information Form (please complete fully prior to your visit).

 

2)  Records Release (so that we may obtain your records from other doctors)

 

3)  Notice of Privacy Practices (for your information, please read)

 

 

FOR ESTABLISHED PATIENTS:

 

1) Download annual physical form - if you are NOT on Medicare please complete this form and bring it to your yearly visit.

 

2) MEDICARE Annual Wellness Visit form. Please complete this prior to your visit if you are on Medicare.

 

3) Outgoing Records Release (to authorize records being sent from our office)

 

 

MDVIP WELLNESS PROGRAM SCREENING FORMS:  Choose   Male   or   Female

 

COVID-19 testing done at Omnia Labs (OmniaDx.com) - Complete their form here and bring to appointment.

 

 

© Windsor Regional Medical Associates, LLC