2 - Forms & Documents
- includes Healthcare Treatment Directive and a Medical Release Form
DOT CDL Physical Form
- If you are getting a DOT physical
Medical Release Form
- Use this for getting information sent to us from other practices. This saves everyone time and effort! (PDF file)
Chronic Care Management Consent
Consent form for Medicare Beneficiaries for Chronic Care Management
DMV - Disabled Placard/Plate
- Form for DMV Disabled Parking
Anthem BC/BS COX-2 Form
- If you are insured with Anthem and you take VIOXX, CELEBREX or BEXTRA. Please fill out this form and bring it in for our signature.
Health Insurance Complaint Form
- Help us keep your insurance company accountable!
WIC Formula Form
- For Medicaid / WIC Moms - Fill out completely!
Wrestling Clearance Form
- Form to fill out if rashes, etc.
VHSL Physical Examination Form
- Form you need completed for high school sports
Info on Advance Medical Directives
Forms for Helping You to Better Health
- Journal to log your exercise
Weight Loss Chart
- Chart to track your weight loss
- chart to log your walking - actual and goals
Glucose Monitoring Form
- to track your blood glucose
- Log for keeping track of what you eat
HEALTH CARE TREATMENT DIRECTIVE+DPOA.pdf
This is your advance medical directive which includes the health care directive and a durable power of attorney