ALL NEW PATIENTS
NEW PATIENT INTAKE, CONSENT & HIPAA FORMS
ALL patients must sign and return this form prior to 1st visit or phone consult.
EXTRA FORMS (if applicable)
AUTHORIZATION for USE & DISCLOSURE FORM
Sign & return if you are 18 or older and are granting permission to Dr. Jana's office to share your personal health information with another person (i.e..parent, spouse, etc.) or to schedule appointments or communicate on your behalf.