Individual Form Components
| Name | Actual document name | Fill out or Read | |
|---|---|---|---|
| New-Patient Forms Package | LOCKE_PRACTICE_NEW_PATIENT_FORMS_PACKAGE.pdf | Fill and Read | |
| The components: | |||
| 1 | Welcome to the Practice | FORM_LOCKE_Welcome_to_Practice.pdf | Read |
| 2 | Patient Registration Form | FORM_LOCKE_Patient_Registration.pdf | Fill |
| 3 | Financial Agreement | FORM_LOCKE_Financial_Agreement.pdf | Fill |
| 4 | Acknowledgement of Receipt of Notice of Privacy Practices | FORM_LOCKE_Acknowledgement_of_receipt_of_Privacy_Practices.pdf | Fill |
| 5 | Telehealth Consent Form | FORM_LOCKE_Telehealth_Consent_Form.pdf | Fill |
| 6 | Email and Text Consent Form | FORM_LOCKE_Email_and_Text_Consent_Form.pdf | Fill |
| 7 | Consent for Use of Medication Form | FORM_LOCKE_Consent_for_Use_of_Medication.pdf | Fill |
| 8 | Questionnaire for New Patients | FORM_LOCKE_Questionnaire_for_New_Patients.pdf | Fill |
| 9 | Notice of Privacy Practices | FORM_LOCKE_Notice_of_Privacy_Practices.pdf | Read |
| 10 | Practice Procedures | FORM_LOCKE_Practice_Procedures.pdf | Read |
| 11 | Best Ways to Contact Me | FORM_LOCKE_Best_Ways_to_Contact_Me.pdf | Read |