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Patient Forms

New Patient
Medical History

4 pages

Patient Consent
Authorization for Treatment

3 pages

Privacy Practices and
Patient Bill of Rights

4 pages

Diabetes Care
Blood Glucose Log

1 page

Early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes.

about how knowing your A1c can help you understand and control your diabetes.

Contact us to schedule a diabetes screening and start your journey to improved health.

Please do not include personal health information in this email form.

Contact us by phone to discuss how to provide personal health information.