Patient Forms

All forms must be printed, filled out and signed prior to any treatment being administered. Please go to this page to watch the video on how to upload these forms to your profile in the HIPAA compliant interface.

Patient Intake Forms

Telehealth Consent Agreement

Practice & Provider Policy of Service Agreement

Cancellation Policy Agreement

Arbitration Agreement

Medical Records Release Form (Only needed if you want to transfer medical records to your other doctors)

If you are having trouble printing or downloading these forms please email info@infantacidrefluxsolutions.com or click contact us.


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