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Pregnant Patient Package

WEBPatient Signature * – Draw your signature below using a tablet, mouse or smartphone. By clicking the Submit button at the end of this form I understand and agree that this is a legal representation of my signature.

Actived: 8 days ago

URL: https://secure.highlandwebforms.com/forms/18146/18668/Mkyw/form.html

New Patient Packet

WEBNew Patient Packet. DIRECTIONS TRAVELING SOUTH ON MILITARY TRAIL: Head south on Military Trail until you get to Clint Moore Road. At Clint Moore Road, turn left (heading east), until you approach the traffic light at Broken Sound Parkway and turn left into The Boca Clinic parking lot. If you reach Congress Avenue, you have passed our building.

Category: Health Go Health

Medical Records Release

WEBMedical Records Release. Patient’s Full Name. Former Name (s) (where applicable) Soc. Sec. No. Date of Birth. Phone. Fax. I, or my personal representative, hereby authorize Signature Medical Group of KC, P.A. (Signature) to use or disclose protected health information regarding my care and treatment. I understand that:

Category: Medical Go Health

Receipt of Privacy Notice

WEBI give Independence Women's Clinic permission to disclose my protected health information to the following individuals involved in my health care and/or payment for health care goods and services.

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Financial Policy

WEBFinancial Policy. Thank you for choosing us as your health care provider. We trust that you will feel warm, comfortable and secure with the medical care you receive. The following is a brief description of our financial policy. Insurance: We participate with many insurance plans, including Medicare. As a courtesy to our patients we will bill

Category: Medical Go Health