Patient Registration & Forms
Please note: Select from the list below to download the patient files
you’ll need for your treatment.
The files are formatted as PDF
(adobe acrobat formatted PDF) .
Download individual files or download all files as a ZIP archive from the links below. Download is immediate.
-
APR Agreement to Receive Electronic Communication DownloadThat the business may communicate with me electronically at the email address and/or phone number listed below.
- APR Workers Compensation Insurance Verification Download
Workers Compensation Insurance Verification
- Health History_Advanced Prosthetic Restorations Download
Health History Form
- New Patient information Form Advanced Prosthetic Restorations Download
New Patient information
- APR Written Order Rx for Prosthetic Services Download
This document must be accompanied by medical records to show medical necessity.
- APR HIPPA Consent Download
Our Notice of Privacy Practices provides information about how we may use and disclose protected health information about you.
- Combined Files Download
All files combined into one ZIP file for convenience.