As a new patient, Dr. Kelling and his staff have provided you with the following forms that can be printed off and filled out prior to your visit. Please be sure to bring the completed forms with you on your first visit! (Please right-click on the links below and select download. They can then be printed off.)
New Patient Form
(PDF Format)
HIPAA Consent Form
(PDF Format)
Consent to Bill Insurance and Payment Agreement
(PDF Format)
HIPAA Authorization Form
(PDF Format)
Notice of Privacy Practices
(PDF Format – Optional Form)
Consent to Treat Minor Form
(PDF Format – As Needed Form)