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."
New Patient Forms
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. Autorización De HIPAA Para Divulgar Información Del Paciente
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.