For your convenience and to save time, please fill out the New Patient Packet that pertains to you and bring it to your first office visit.
The PDF packets are available for you to print and fill out manually or they are screen-fillable. Screen-fillable means you can enter your data on the screen before printing. We highly recommend you fill out the required fields in the packets on the screen, then print the forms out to finish filling in the information and/or providing a signature. Please note that you will not be able to save your data to your PC when filling it out on the screen.
NEW PATIENT PACKETS
Tottori New Patient Packet – ADULT v9
Tottori New Patient Packet – PEDIATRIC v9
INDIVIDUAL FORMS
Tottori Medical Records REQUEST Form
Tottori Medical Records Use and Disclosure Authorization Form
HIPAA Notice of Privacy Practices
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