Patient Forms
All forms must filled out and signed prior to any appointments being scheduled. Please go to this page to watch the video on how to upload these forms to your profile in the HIPAA compliant interface.
Also, if you don't have a printer, don't worry. These forms are online interactive. If you are on your phone you can click on the links below that will open the documents on a separate page.
Then you will need to forward that page to your applications. If you click "MORE" you should see the option to send to Adobe Acrobat.
That is where the forms will be interactive on your phone. Please connect with our support team if you need assistance with this.
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)
PED Nutritionist Patients See Below
For all patients with PED Nutritionist Mary Graham, please also fill out this questionnaire. The response will be sent to our patient coordinator and we will upload into your appointment for you.
Trouble with the forms?
If you are having trouble printing or downloading these forms please email support@infantacidrefluxsolutions.com or click contact us.