Please complete and submit these HIPPA compliant forms prior to your child/children’s well visit each year
Wavier for Vision Testing (Ages 1 and 2) (Does not apply to patients with Husky insurance)
Wavier for Hearing and Vision testing (Ages 3 and older) (Does not apply to patients with Husky insurance)
Waiver for non-covered services Use this form to agree to services provided in our office for baseline screening EKGs and ImPACT concussion testing.
Click here to review Financial policy
Click here to review Notice of Privacy Practices
Upload a copy of your insurance card
Complete this form if you need to update any demographic or insurance information (eg. address, email address, insurance information)