Please print these forms and bring them with you to your first office visit:

• Patient Demographics
• Patient Medical History
• HIPAA Form
• Authorization to Disclose Medical Information
• New Patient Pain Medication Agreement
• Office and Financial Policy (signature page only)
• Notice of Privacy Practice (for your information)

• Asthma Action Plan
• COPD Action Plan
• Diabetes Action Plan
• Epworth Sleepiness Scale
• STOP BANG Questionnaire
• Blood Pressure Log
• Blood Sugar Log