New patient forms for Dr. Bassett
All patients must have the following forms signed and completed prior to first visit:
- New Patient Intake Form OR New Patient Intake Form – Pediatric
- Office Policy Agreement
- Notice of Patient Privacy
- Insurance Registration Form
- Insurance Verification Checklist
If you have medical records from other practitioners that would help us with your care, please download and complete the Release of Records Form.
Note: Follow-up with your provider from whom you’ve requested records to make sure they’ve been sent before your first visit. In our experience, this can sometimes be a timely process.