Patient Forms
Prior to being seen in the office, we need to obtain information from you. This includes general demographics, medical history, and insurance information.
Please complete the patient demographis form, one history & physical form, read the privacy policy act, and compete the acknowledgement form.
Patient Demographics Form:
Patient Demographics Form (pdf)
History and Physical Forms:
*After you have made your appointment please fill out the following history and physical form for the physician you will be seeing.
Dr. David Fajgenbaum (pdf)
Dr. Michael Fajgenbaum (pdf)
Dr. Michael Comstock (pdf)
Dr. Paul Burroughs III (pdf)
Dr. James Crowther (pdf)
Dr. David Jones (pdf)
Privacy Policy Information:
Privacy Policy Act (pdf)
* Please review the privacy policy information provided above.
* Press 'Agree' below and the Privacy Policy Act Acknowledgement pdf will open. Please sign and date the acknowlegment form. Do not forget to bring the forms with you for your office visit.