All forms below require the free Adobe Acrobat Reader. If you don't have it, please click HERE to download.

PLEASE CHOOSE A FORMS PACKAGE FOR CASH, AUTO OR MAJOR MEDICAL INSURANCE:

CASH PATIENTS Please Fill Out This Forms Package
**On the first page, please insert name on first line and sign and date at the bottom of the page! Then fill out the rest of the package!

AUTO ACCIDENT PATIENTS Please Fill Out This Forms Package

ALL MAJOR MEDICAL INSURANCE PATIENTS Please Fill Out This Forms Package

ONLY FOR Auto and Major Medical packages: included is a Health Insurance claim form: sign & date boxes 12 & 13 ONLY on this form!

ONLY FOR United HealthCare and Great West Insurance: please ALSO fill out this form:
Patient Summary Form
**Please fill out Patient Information at top of form, and Patient Completes This Section at the bottom of the page!