Patient Forms

What you need for your first visit:

What you need for your first visit:

Please download, print, fill out (USE PEN FOR # 1-4), and bring in with you:

  1. Patient registration form (pages 1&2)
  2. HIPPA patient privacy form
  3. Cancellation/no show policy/ Financial policy
  4. Medicare Patient Questionnaire (for original Medicare as well as supplemental policies)
  5. If you have any of the conditions below, download, print, USE A PENCIL (NOT a pen). fill out and bring the form that applies:  (Do not worry about scoring – just answer according to how you feel over the past day or two)


Serving Central Connecticut – Conveniently located at:
400 Middle St (Rt 229 in the Gym building), Bristol, CT 06010

 

FOR APPOINTMENT CALL 860-589-0444

Open Monday – Thursday 9a.m. to 6p.m. and Saturday 9a.m. to noon