Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.
"In 2014 I went into full blown menopause, and was told about Dr. Miskell after sharing about my hot flashes and anxiety with a nurse at my eye Dr’s office. I have been a monthly patient ever since. I am always greeted warmly and compassionately by nurses and Staff. Rae Benson is the PA I see monthly and is truly concerned for any needs that I have. I am grateful and have been blessed by that original referral to this office and have paid it forward numerous times by referring others."
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.