Patient Forms

Use the following links to download patient forms. Once open, print the forms and then bring your completed forms to the visit.
[PDF/printable page help]

Required forms:

• Patient Health History Form (PDF)
• New Patient Info Form (PDF)
• Medical Records Release Form (PDF)

Optional forms:

• Reason for Visit Questionnaire
  (to help prepare for a visit)
• What to Ask Your Doctor
  (for notetaking during a visit)

What to Bring to Your Appointment

• Your insurance card
• Physician referral forms if required by insurance
• A list of current prescription or over-the-counter medications you are taking, including dose and frequency
• Pertinent information about your medical and surgical history
• Any recent x-rays or appropriate records you may have

Payment and Insurance Information

Dr. Fosmire and Dr. Gorman are providers for Medicare and most major insurance plans. We provide insurance billing. Anything not covered by insurance will be your responsibility.

We request payment at the time of your appointment for services that are not covered by insurance. Your insurance company may also require you to pay a co-payment at the time of your appointment. When necessary, our staff will work closely with patients who require a payment plan.