Patient forms and info

FOR NEW PATIENTS:

Please click on the following link and then click on "Download" to download the NEW PATIENT INTAKE FORM (PDF).  You will need to print the last seven pages of this PDF file, read the instructions on each page carefully, complete all pages (remember to initial the middle of the last page), and bring them unstapled to your appointment. 

FOR PATIENTS COMING FOR FOLLOWUP VISITS:

Before each visit, please click on the following link and then download the one-page  PREFOLLOWUP OFFICE VISIT QUESTIONNAIRE, print it, complete all questions, and bring it with you to your appointment.  This will ensure that we:  1. don't forget to cover any important issues; 2. don't waste time asking and answering repetitive questions at each visit; 3. utilize the available time more effectively to talk about your particular concerns.  As this form is periodically revised, please download the latest version shortly before your appointment.

FOR ALL PATIENTS:

The following are provided for your reference but do not need to be printed:

HIPAA Privacy Notice

Office Policies

Regarding Electronic Prescribing

Sleep and Mood Log (this may be printed if you wish to use it)

If you need to have information sent to or from Dr. Tobolowsky, the following forms may be downloaded, printed, and completed to enable release of medical information, as indicated:

Authorization form for another doctor or hospital to release information to Dr. Tobolowsky

Authorization form for Dr. Tobolowsky to release information to another doctor

 

 

 

 

Print Print | Sitemap
© David M. Tobolowsky, M. D. - 1&1 MyWebsite