Prior to your visit, please download and print these forms. Filling these out prior to your appointment will streamline your visit. You may also review and sign the four privacy and agreement forms in the Patient Portal under “medical 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.
telemedicine consent – Please download and sign this for our records
Mary Stanley MD 