Select your form from the list below. When complete, you may submit online or fax (401-333-5215), or mail, or drop off your forms to the office.
Medical Release Form
What is it for?
To release/obtain copies of patient medical records for transfer, legal, medical or personal purposes. DOWNLOAD FORM or fill in the ONLINE FORM for a direct and secure submission.
New Patient Packet
What is it for?
This packet is for new patients to fill out at or before their first appointment. It includes an information sheet, a financial responsibility form, a copy of the HIPAA privacy policy to read and a signature page to acknowledge that the patient/guardian has read and understands the terms of the HIPAA privacy policy. DOWNLOAD FORM or fill in the ONLINE FORM for a direct and secure submission.
Patient Consent Form
What is it for?
For patients' over the age of 18 to sign if they wish to allow certain approved individuals to access their medical information. DOWNLOAD FORM
or fill in the ONLINE FORM for a direct and secure submission.
HIPPA Form
Who is it for?
All current patients. This form needs to be completed/updated on an annual basis for all current patients. DOWNLOAD FORM or fill in the ONLINE FORM for a direct and secure submission.
Patient Information Sheet
Who is it for?
All current patients. This form needs to be completed/updated on an annual basis for all current patients. DOWNLOAD FORM or fill in the ONLINE FORM for a direct and secure submission.