New Patients

As a new patient, Dr. Kelling and his staff have provided you with the following forms that can be downloaded, printed and filled out prior to your visit.  Please be sure to bring the completed forms with you on your first visit!

New Patient Form

New-Patient-formDownload

HIPAA Consent Form

HIPAA-Consent-FormDownload

Consent to Bill Insurance and Payment Agreement

Consent-to-bill-insurance-and-payment-agreementDownload

HIPAA Authorization Form

HIPAA-AUTHORIZATION-FORMDownload

Notice of Privacy Practices

(Optional Form)

Notice-of-Privacy-PracticesDownload

Consent to Treat Minor Form

(As Needed Form)

Consent_to_Treat_Minor_Form-1Download
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