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Patient Forms

Instructions:

  1. Please click the links below to download the required forms for your next appointment:

  2. Please read each document throughly and complete with your information.

  3. Print each form and bring them in with you for faster service at your next appointment.

  4. These forms are required and include specific instructions, please review and populate carefully.

  5. If you have any questions please us our contact form or give us a call at: (406) 327-4395

 

  • Personal Information and HIPPA Notice of Privacy Practices:

    • Please fill out this form (FRONT & BACK) to the best of your ability then sign the bottom of the front and back. The back of this form describes how medical information about you may be used by our office and/or a third party as well as giving our office permission to share your info with said parties.
  • Financial Agreement:

    • Please carefully read the front and back of this form then sign on the line at the bottom. This is an explanation of your responsibility as our patient to update your information, ensure your financial cooperation and general expectations we have for our patient clientele. By signing, you agree to uphold our policies.
  • Contact Information:

    • Please give any and all contact information possible, indicate your preferred contact and whether we are allowed to leave a message at any of these possible forms of contact.
  • Insurance Agreement:

    • Please read this form carefully as it concerns and explains our protocol for payment before and after ALL appointments. Initial next to one of the two options that applies personally to you then sign and date the bottom line.
  • Patient History:

    • Please fill out this form (FRONT & BACK) to the best of your ability and list any additional questions or concerns at the bottom of the page.
  • Family History:

    • Please fill out this form to the best of your ability. Please write legibly and be sure to include the ages of your relatives.

Thank you so much for completing all of our paper work to the best of your ability, we do understand this isn’t the most fun and your time is very valuable to us, we do truly appreciate it.  Please return all paperwork to reception when it is completed, thank you!!!

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