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OFFICE FORMS
If you are a New Patient, you may Download and Print the Forms below at home, and read and enter the information.
If you forgot your Forms / have not filled them out prior to the first appointment, they can be found on the Green Clip Board in the Waiting Area.
You will receive a "Confirmed" email that will have these forms AND Instructions for adding your History to the Portal, along with a Portal Invite. Please READ everything and do the best that you can to provide as much information as possible...it saves time during the visit !
Every New Patient is required to complete:
(1) Patient Registration Form (registration.pdf) ,
(2) Patient Privacy Notice
(3) Medicare Contract that you sign your UNDERSTANDING that I DO NOT PARTICIPATE WITH MEDICARE AND NO REIMBURSEMENT IS POSSIBLE.
If you would like to Print and Sign a Medical Release, it is also available below.
If you have had a Brain Insult (Traumatic, Metabolic or Emotional) or Chronic Fatigue-type Symptoms, please complete the History on the Portal. This can save a lot of time describing your symptoms, as so many symptoms are listed on the Questionnaire.
If you would like to read a copy of the Federal "Notice of Privacy Practices" (hipaa-article.pdf), this is available below. Although there is nothing to complete on this last Form, and it does not have to be printed, I have included it here as you are required to acknowledge, by Federal Law, that you have the opportunity to view it.
Thank you for visiting our website, I look forward to seeing you in the office!
Dr Gaydos
© James Edward Gaydos DO. All Rights Reserved.
If you are a New Patient, you may Download and Print the Forms below at home, and read and enter the information.
If you forgot your Forms / have not filled them out prior to the first appointment, they can be found on the Green Clip Board in the Waiting Area.
You will receive a "Confirmed" email that will have these forms AND Instructions for adding your History to the Portal, along with a Portal Invite. Please READ everything and do the best that you can to provide as much information as possible...it saves time during the visit !
Every New Patient is required to complete:
(1) Patient Registration Form (registration.pdf) ,
(2) Patient Privacy Notice
(3) Medicare Contract that you sign your UNDERSTANDING that I DO NOT PARTICIPATE WITH MEDICARE AND NO REIMBURSEMENT IS POSSIBLE.
If you would like to Print and Sign a Medical Release, it is also available below.
If you have had a Brain Insult (Traumatic, Metabolic or Emotional) or Chronic Fatigue-type Symptoms, please complete the History on the Portal. This can save a lot of time describing your symptoms, as so many symptoms are listed on the Questionnaire.
If you would like to read a copy of the Federal "Notice of Privacy Practices" (hipaa-article.pdf), this is available below. Although there is nothing to complete on this last Form, and it does not have to be printed, I have included it here as you are required to acknowledge, by Federal Law, that you have the opportunity to view it.
Thank you for visiting our website, I look forward to seeing you in the office!
Dr Gaydos
© James Edward Gaydos DO. All Rights Reserved.
| 1-registration.pdf |
| 2-privacy_notice.pdf |
| 3-medicare_notice.pdf |
| 6-hipaa_article.pdf |
| 7-medical_release_form.pdf |