Patient Forms

 
New Patient Information Form: Provides TJC with your address, contact information, and insurance information. Please bring your insurance card(s) with you.

New Patient Information Form

Patient Authorization Form: Allows TJC access to any pertinent medical records for your treatment. Also authorizes billing on our behalf.

Patient Authorization Form

Patient Intake Questionnaire: Provides TJC with your medical and surgical history.

Patient Intake Questionnaire

Patient Privacy Information (HIPAA):The HIPAA Privacy Rule, which protects the privacy of individually identifiable health information, and the confidentiality provisions of the Patient Safety Rule, helps protect identifiable information being used to analyze patient safety events and improve patient safety. Please review the provisions followed at our office.

Patient Privacy Information (HIPPA)