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New Patient Packet Please arrive 15 minutes prior to your initial appointment and bring your valid insurance card or HMO authorization notice. If you've had recent diagnostic studies taken elsewhere such as X-rays or MRI services, it is necessary that you bring them to your appointment. Also, if you have any written reports from physicians outside of our medical group, please bring them to your appointment. The following forms can either be filled out online (use your "tab" key on your keyboard to move from field to field and type in the information) and then print them out, or you may just print them out and fill in the information by hand. Some forms you will have to physically sign your signature to once you have printed out the completed form. GOS WEB Patient Registration Form.docGOS Health History.doc GOS WEB Use and Disclosure Consent Form.doc GOS WEB ENR Worker's Comp Info Sheet.doc (For Dr. Rickards' worker's comp patients only) The forms listed below are only printable and you must sign and date the forms. GOS Financial Policy.doc GOS Receipt of Notice of Privacy.doc The forms listed below are only printable and for you to keep, not return. GOS Additional Services Info.doc GOS Notice of Privacy.doc GOS Arbitration Agreement Letter.doc Please be sure to bring the completed forms with you on your first appointment. Patient Survey Please fill out the patient survey so that we know how we are doing. GOS WEB Patient Survey.doc. |
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