The following nine forms must be completed, printed, and brought to your first appointment.
 

PATIENT Information FORM

Type: editable document

Version: 4.0   |   Revised: 07/31/2008   |   File size: 71KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

Treatment Consent Form: Signature Confirmation Page

Type: Signature confirmation

Version: 3.0   |   Revised: 03/18/2008   |   File size: 61KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

Consent to Release and Request Information

Type: editable document

Version: 2.0   |   Revised: 07/31/2008   |   File size: 106KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

Insurance Form

Type: editable document

Version: 4.0   |   Revised: 04/24/2017   |   File size: 74KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

Failed Appointment Policy

Type: Viewable Policy

Version: 2.0   |   Revised: 07/31/2008   |   File size: 32KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

PATIENT RIGHTS: signature confirmation page

Type: Signature confirmation

Version: 2.0   |   Revised: 03/19/2008   |   File size: 23KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

NOTICE OF HIPAA PRIVACY PRACTICES: signature confirmation page

Type: Signature confirmation

Version: 2.0   |   Revised: 03/17/2008   |   File size: 50KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

PATIENT MEDICAL HISTORY & PHYSICAL SCREENING

Type: editable document

Version: 13.0   |   Revised: 08/06/2008   |   File size: 660KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

PATIENT MEDICATION LIST

Type: editable document

Version: 1.1   |   Revised: 09/29/2009   |   File size: 172KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

 
The following forms are for your information only,  but we recommend that you read them.
 

New Patient Information Packet: Table of Contents

Type: Printable Document

Version: 2.0   |   Revised: 03/19/2008   |   File size: 34KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

About your treatment at CPG

Type: FAQ (Frequently Asked Questions)

Version: 2.0   |   Revised: 07/31/2008   |   File size: 32KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

NOTICE OF HIPAA PRIVACY PRACTICES

Type: Viewable Policy

Version: 2.1   |   Revised: 03/17/2008   |   File size: 28KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

PATIENT RIGHTS

Type: Viewable Policy

Version: 3.0   |   Revised: 03/19/2008   |   File size: 42KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

PATIENT CONCERN & COMPLAINT FORM

Type: editable document

Version: 2.0   |   Revised: 03/02/2008   |   File size: 137KB

This file requires the following program(s):  Adobe Reader 9.0 or higher

 
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