Registration, records release, and authorization forms for MIP should be emailed to:
For forms requiring completion by one of our providers, please note the following:
We charge $20.00 per patient, per form.
Turnaround time for form completion is 24-48 hours.
If the form is needed same day, the charge is $40.00.
Payment is due at the time of the request, and we do not bill for forms.
All forms must be emailed to firstname.lastname@example.org
If you wish to have any forms mailed back to you, please provide a self-addressed, stamped envelope.
Please complete the patient/history portion of forms prior to exam appointment - doctors are unable to complete and sign until you have done so