Patient Paperwork

To become a new patient, please fill out New Patient Paperwork and NOTICE OF PRIVACY PRACTICE information available below and submit with a copy of your driver’s license and insurance card. You may fax, mail or drop off to our office. A staff member will call you with some of our policies. After your paperwork has been entered, another staff member will call you to get an appointment.  Please bring in your insurance card(s), driver’s license, and co-pay and arrive 15 minutes ahead of your scheduled appointment. If you have a deductible, a $40 fee will be charged at time of check-in.

If you have not been in for more than ONE year, you will need to fill out the NOTICE OF PRIVACY PRACTICE information and bring it with you to your next appointment. If you have not been seen in over THREE years, you are considered a new patient and will need to follow instructions above. Please bring in your insurance card(s), driver’s license, and co-pay and arrive 5 minutes ahead of your scheduled appointment. If you have a deductible, a $40 fee will be charged at time of check-in.

We have a $50 fee for appointments not canceled 24 hours before appointment or for a missed appointment.

Print

New Patient Paperwork

HIPAA/No Show Form

Read

Notice of Privacy Practices

Birmingham Integrative Health Policies