Dr. Susan Schmitt, M.D. Downloadable Forms

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These forms are specifically for Dr. Susan Schmitt, M.D.


New Patient Packet

Dr. Schmitt M.D.: New Patient Packet.zip

Includes all forms below in a .zip compressed archive.

If you don’t already have a program to handle zip files, you can download and install this one from RARLab for free, available for PC, Mac, and more; click the link appropriate to your specific operating system.

All PDF forms can be filled out with Adobe’s Acrobat Reader.


Welcome to Our Office.pdf

NOTICE_PATIENT_PRIVACY

Patient Privacy Notice Form.pdf

(To be filled out)

Schmitt_FINANCIAL_POLICY_ACKNOWLEDGEMENT

Dr. Schmitt M.D.: Financial Policy Acknowledgement Form.pdf

(To be filled out)

PATIENT_REGISTRATION

Patient Registration Form.pdf

(To be filled out)

Schmitt_NEW_PATIENT_FORM

Dr. Schmitt M.D.: New Patient Form.pdf

(To be filled out)

AUTHORIZATION_TO_RELEASE_RECORDS

Authorization to Disclose Health Information.pdf

(To be filled out)

Takacs-NOTICE_OF_PRIVACY_PRACTICES

Dr. Schmitt M.D.: Privacy Practices.pdf