Patient Forms

Prior to your visit, please download and print these forms.  Filling these out prior to your appointment will streamline your visit.

Forms:

NewPatientIntakeForm. – A health history form, please be as complete as possible

Health Information Practices Summary – Please read prior to signing the HIPPA consent below.

HIPPA Consent – Please read the Health Information Practices Summary and then sign this form acknowledging that you have read the summary.

Medical Records Release Form – This will allow Dr. Stanley to retrieve your records from UVM and other hospitals.  Having this form on record can expedite your care.

Patient Financial Agreement – Please print, read and sign this agreement to provide insurance information as well as timely payment of copays and coinsurance.