Dr. Takacs Forms
Dr. Takacs Forms
- Patient Registration Form - Complete form and submit
- Notice of Patient Privacy - Read, sign, and submit
- Financial Policy - Read, sign, and submit
- Health History -
Complete form and submit
- Injury Form - For Injuries Only - Complete form and submit
- Authorization for Communication of Protected Health Information to Family and Friends - Complete form, sign, and submit (Optional)
- Authorization to Disclose Health Information - Print and sign (Optional)
- Welcome to Our Office - Read only
- Patient Privacy Notice - Read only
Contact us today!
503-234-1531
At Takacs Clinic, we offer complimentary water and Wifi.