headerphoto

We look forward to your visit to our office!  We require that you complete the following forms to assure that:

  • You are familiar with our privacy practices
  • We maintain an accurate medical history
  • We have information on your other health providers who might need access to records from your visit
  • We have accurate insurance information

Please see the table below containing the links and instructions for these forms which are required for new patients:

Form (Click to download) Instructions
HIPAA Notice of Privacy Practices Print and retain for your records
HIPAA Summary of Notice of Privacy Practices Print, sign, and bring to the office

* You may type onto the starred UTMG Surgery forms on a computer and print them out with the information you added. However, these forms cannot be saved on the computer with your data on them.