Forms

Please refrain from using scented body products on the day of your appointments (cologne/perfume, hairspray, scented lotions, scented soaps). This is very important to our chemically sensitive patients!

 – Thank you. – Dr. Hanus

For your convenience and to save your time upon arrival we have provided  attachments of patient information documents needed for your appointment.

Please print off all of  the documents and fill out all of the information to the best of your ability prior to your arrival.  If you have an extensive history, complex or extenuating circumstances, please include additional information on a separate paper.

This may include prescription medications being taken or treatments for specific issues in your past.

These documents are required by law for your safety and privacy. Please bring all of the documents with you to your appointment.  If time allows, please mail or fax them prior to your appointment.

***HIPPA Notice form is for you to keep and read over. It is not to be turned in with the other forms for your initial visit.***    

 

Patient Registration

Medical History

Dental History

Financial policy

HIPPA –  Notice of Privacy Practices 

Reciept of HIPPA

Consent for use

Addendum-HIPPA

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